About sepsis screening

This article is for Nervecentre Sepsis Screening for NICE guidelines from February 2024.

Nervecentre’s clinical rules can identify sepsis markers in adult inpatients, and trigger associated workflows in real time.

The NICE (National Institute of Clinical Excellence) guideline Sepsis: recognition, diagnosis and early management outlines thresholds that are red or amber flags for sepsis. For example, a NEWS equal to or greater than 7 is a red flag for sepsis. These thresholds are set as conditions in Nervecentre. When observations are recorded, Nervecentre evaluates the patient's NEWS National Early Warning Score. A vital signs recording and scoring system used with adult patients. The scoring system is designed to identify and alert appropriate staff in the case of deteriorating patients. and other risk factors against these conditions. Where thresholds are met or exceeded, the clinical rules trigger a workflow.

Positive triggers update clinical notes and patient tags, and send tasks to appropriate clinicians to ensure timely identification and treatment of patients with suspected sepsis.

Tasks involved in sepsis screening are mainly managed on a mobile. Depending on your permissions, you might be able to do some activities on a desktop.

Sepsis screening takes place after recording a set of observations. A set of observations might give a National Early Warning Score (NEWS).

Read more about observations

Nervecentre evaluates the patient's NEWS National Early Warning Score. A vital signs recording and scoring system used with adult patients. The scoring system is designed to identify and alert appropriate staff in the case of deteriorating patients. and other risk factors against NICE thresholds to determine which if a patient might have sepsis.

NEWS Other risk factors Result What happens
7 or more - Positive

  • The clinical note 'Sepsis Screening' updates to Sepsis Screening In Progress.

  • Nervecentre sends the task 'Red High Risk Sepsis Think Task' to all nurses with the patient on their patient list.

  • Re-screening for sepsis is scheduled in 30 minutes, as a safeguard in case the task is not answered.

Read more about the workflow for 'Red' sepsis

5 or 6

One of the following:
5 or 6 None Positive

  • The clinical note 'Sepsis Screening' updates to Sepsis Screening In Progress.

  • Nervecentre sends the task 'Amber Moderate Risk Sepsis Think Task' to all nurses with the patient on their patient list.

  • Re-screening for sepsis is scheduled in 30 minutes, as a safeguard in case the task is not answered.

Read more about the workflow for 'Amber' sepsis

1 to 4

One of the following:

  • An EWS of 3 in 1 parameter

  • Skin perfusion recorded as non-blanching rash, cyanotic, mottled, or ashen
1 to 4 None Negative

  • The clinical note 'Sepsis Screening' updates to Sepsis Screened.

  • Re-screening for sepsis is scheduled for the next set of observations.

When observations meets specific criteria, Nervecentre automatically sends tasks and alerts to appropriate clinicians. Both tasks and alerts arrive as notifications on a mobile device.

Alerts are information only, and clinicians only need to acknowledge the alert. Tasks are actions. Clinicians can accept the task, which is then added to their own task list.

Read more about tasks and alerts

Sepsis screening has a 'Think' task. A 'Think' task asks a nurse if they think the patient might have sepsis.

Read more about the workflow for 'Red' sepsis

Read more about the workflow for 'Amber' sepsis

Re-screening patients for sepsis occurs after specific periods of time. The time before re-screening depends on the tasks sent, and the answers received. This ensures that not every set of observations starts sepsis screening.

Observations are recorded.

If a patient's NEWS National Early Warning Score. A vital signs recording and scoring system used with adult patients. The scoring system is designed to identify and alert appropriate staff in the case of deteriorating patients. is 7 or more, or their NEWS is equal to 5 or 6 and they have one other risk factor:

  • The clinical note 'Sepsis Screening' updates to show Sepsis Screening In Progress.

  • The task 'Red High Risk Sepsis Think Task' to all nurses with the patient on their patient list.

  • Re-screening for sepsis is scheduled in 30 minutes, as a safeguard in case the task is not answered.

A nurse answers the task 'Red High Risk Sepsis Think Task'.

  • If the nurse selects Not Sepsis - Alternative Diagnosis:

    • The clinical note 'Sepsis Screening' updates to show Sepsis Unlikely.

    • Re-screening for sepsis is scheduled in 6 hours, as a safeguard in case the patient's condition changes.

  • If the nurse selects Yes concern of Sepsis/Deterioration since last review? or Any recent Chemo/Risk of Neutropenic Sepsis?:

    • The clinical note 'Sepsis Screening' updates to show Sepsis Suspected.

    • The tag SEPSIS appears under the patient's name.

    • The task 'Red High Risk Sepsis Doctor Alert' is sent to doctors with the patient on their patient list.

      At night, or out of hours, this task is sent to a task coordinator instead. A task coordinator assigns the task to an appropriate, available clinician.

      Read more about the workflow at night, or out of hours

    • The task 'Red High Risk Sepsis Nurse Alert' is sent to nurses with the patient on their patient list.

    • The alert 'Red High Risk Sepsis NIC Alert' is sent to the Nurse in Charge.

    • Re-screening for sepsis is scheduled in 4 hours, as a safeguard in case the task 'Red High Risk Sepsis Doctor Alert' is not answered.

A doctor answers the task 'Red High Risk Sepsis Doctor Alert'.

  • If the doctor selects Not Sepsis Alt. Diagnosis:

    • The alert 'This is NOT Red High Risk Sepsis' is sent to nurses with the patient on their patient list.

    • The clinical note 'Sepsis Screening' updates to show Sepsis Unlikely.

    • Re-screening for sepsis is scheduled in 6 hours, as a safeguard in case the patient's condition changes.

  • If the doctor selects Assessment Pending:

    • The task 'Red High Risk Sepsis Doctor Alert' remains open.

  • If the doctor selects Sepsis Likely - Rx Started:

    • The clinical note 'Sepsis Screening' updates to show Red Sepsis Treatment Commenced.

    • The tag SEPSIS appears under the patient's name.

    • Re-screening for sepsis is scheduled in 24 hours, as a safeguard in case the patient’s condition changes despite sepsis treatment being in place.

An NIC receives and acknowledges the alert 'Red High Risk Sepsis NIC Alert'.

A nurse answers the task 'Red High Risk Sepsis Nurse Alert'.

The nurse accepts the task and selects Started or Completed. Completed closes the task.

A doctor sets the clinical note 'Sepsis Screening' to Sepsis Treatment Completed.

  • Re-screening for sepsis is scheduled for the next set of observations.

Observations are recorded.

If a patient's NEWS National Early Warning Score. A vital signs recording and scoring system used with adult patients. The scoring system is designed to identify and alert appropriate staff in the case of deteriorating patients. is 5 or 6 and they have no other risk factors, or their NEWS is between 1 and 4 and they have one other risk factor:

  • The clinical note 'Sepsis Screening' updates to show Sepsis Screening In Progress

  • The task 'Amber Moderate Risk Sepsis Think Task' to all nurses with the patient on their patient list.

  • Re-screening for sepsis is scheduled in 30 minutes, as a safeguard in case the task is not answered.

A nurse answers the task 'Amber Moderate Risk Sepsis Think Task'

  • If the nurse selects Not Sepsis - Alternative Diagnosis:

    • The clinical note 'Sepsis Screening' updates to show Sepsis Unlikely.

    • Re-screening for sepsis is scheduled in 6 hours, as a safeguard in case the patient's condition changes.

  • If the nurse selects Yes concern of Sepsis/Deterioration since last review?:

    • The clinical note 'Sepsis Screening' updates to show Sepsis Suspected.

    • The tag SEPSIS appears under the patient's name.

    • The task 'Amber Moderate Risk Sepsis Doctor Alert' is sent to doctors with the patient on their patient list.

    • The task 'Amber Moderate Risk Sepsis Nurse Alert' is sent to nurses with the patient on their patient list.

    • The alert 'Amber Moderate Risk Sepsis NIC Alert' is sent to the Nurse in Charge.

    • Re-screening for sepsis is scheduled in 4 hours, as a safeguard in case the task 'Amber Moderate Risk Sepsis Doctor Alert' is not answered.

  • If the nurse selects Any recent Chemo/Risk of Neutropenic Sepsis?:

    Nervecentre follows the red sepsis workflow.

    • The clinical note 'Sepsis Screening' updates to show Sepsis Suspected.

    • The tag SEPSIS appears under the patient's name.

    • The task 'Red High Risk Sepsis Doctor Alert' is sent to doctors with the patient on their patient list.

      At night, or out of hours, this task is sent to a task coordinator instead. A task coordinator assigns the task to an available an appropriate clinician.

      Read more about the workflow at night, or out of hours

    • The task 'Red High Risk Sepsis Nurse Alert' is sent to nurses with the patient on their patient list.

    • The alert 'Red High Risk Sepsis NIC Alert' is sent to the Nurse in Charge.

    • Re-screening for sepsis is scheduled in 4 hours, as a safeguard in case the task 'Red High Risk Sepsis Doctor Alert' is not answered.

    Read more about the workflow for 'Red' sepsis

A doctor answers the task 'Amber Moderate Risk Sepsis Doctor Alert'.

  • If the doctor selects Not Sepsis Alt. Diagnosis:

    • The alert 'This is NOT Amber Moderate Risk Sepsis' is sent to nurses with the patient on their patient list.

    • The clinical note 'Sepsis Screening' updates to show Sepsis Unlikely.

    • Re-screening for sepsis is scheduled in 6 hours, as a safeguard in case the patient's condition changes.

  • If the doctor selects Assessment Pending:

    • The task 'Amber Moderate Risk Sepsis Doctor Alert' remains open.

  • If the doctor selects Sepsis Likely - Rx Started:

    • The clinical note 'Sepsis Screening' updates to show Amber Sepsis Treatment Commenced.

    • The tag SEPSIS appears under the patient's name.

    • Re-screening for sepsis is scheduled in 24 hours, as a safeguard in case the patient’s condition changes despite sepsis treatment being in place.

An NIC receives and acknowledges the alert 'Amber Moderate Risk Sepsis NIC Alert'.

A nurse answers the task 'Amber Moderate Risk Sepsis Nurse Alert'.

The nurse accepts the task and selects Started or Completed. Completed closes the task.

A doctor sets the clinical note 'Sepsis Screening' to Sepsis Treatment Completed.

  • Re-screening for sepsis is scheduled for the next set of observations.

The sepsis screening workflow at night, or out of hours, is mostly the same as the workflow during the day, but there is a key difference.

If a nurse answers a 'Think' task and they suspect the patient has sepsis, Nervecentre sends the 'Sepsis Doctor Alert' task to a task coordinator instead of a doctor. A task coordinator then manually assigns the task to an available and appropriate clinician.

Read more about manually allocating tasks

Nervecentre automatically updates the clinical note ‘Sepsis Screening’ during the sepsis screening process, except for the last step, setting 'Sepsis Screening' to 'Sepsis Treatment Completed', which must be manually completed.

Not screened for Sepsis

This is the default value, shown when the patient is admitted.

Sepsis Screened

This shows automatically when observations have been recorded, but there are no red or amber flags for sepsis.

Sepsis Screening In Progress

This shows automatically when the task 'Red High Risk Sepsis Think Task' or 'Amber Moderate Risk Sepsis Think Task' has been sent but not answered.

Sepsis Suspected

This shows automatically when the task 'Red High Risk Sepsis Think Task' or 'Amber Moderate Risk Sepsis Think Task' is answered with Yes concern of Sepsis/Deterioration since last review? or Any recent Chemo/Risk of Neutropenic Sepsis?.

Nervecentre creates a blue patient tag.

Read more about patient tags

Red Sepsis Treatment Commenced

This shows automatically when the task 'Red High Risk Sepsis Doctor Alert' is answered with Sepsis Likely - Rx Started.

Nervecentre creates a red patient tag.

Read more about patient tags

Amber Sepsis Treatment Commenced

This shows automatically when the task 'Amber Moderate Risk Sepsis Doctor Alert' is answered with Sepsis Likely - Rx Started.

Nervecentre creates an amber patient tag.

Read more about patient tags

Sepsis Unlikely

This shows automatically when:

  • The task 'Red High Risk Sepsis Think Task' or 'Amber Moderate Risk Sepsis Think Task' is answered with Not Sepsis - Alternative Diagnosis.

    Or

  • The task 'Red High Risk Sepsis Doctor Alert' or 'Amber Moderate Risk Sepsis Doctor Alert' is answered with Not Sepsis Alt. Diagnosis.

Sepsis Treatment Completed

This must be manually set when the patient's sepsis treatment has been completed.

Read more about setting 'Sepsis Screening' to 'Sepsis Treatment Completed'

When you view a patient's record, you can view patient tags. Patient tags appear directly under the patient's demographics.

Nervecentre updates patient tags for sepsis when tasks are progressed or the clinical note 'Sepsis Screening' is set to 'Sepsis Treatment Completed'.

SEPSIS

Blue sepsis tag: Sepsis suspected

SEPSIS

Amber sepsis tag: Amber sepsis treatment commenced

SEPSIS

Red sepsis tag: Red sepsis treatment commenced
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