Clinical Learning
Clinical 1: Suspected sepsis in adults
Recognising suspected sepsis, evaluating risk, escalating care and applying current NICE guidance in adults aged 16 or over.
Clinical safety: Use current guidance, local policy and patient-specific judgement.
Learning objectives
• Recognise clinical features that should prompt consideration of sepsis • Use NEWS2 and clinical concern together when evaluating risk in acute hospital settings • Describe escalation principles for high, moderate and low risk presentations • Explain why source control, monitoring and timely antimicrobial decisions matter • Recognise when local antimicrobial guidance and senior review are essential
Clinical safety note
Sepsis guidance changed substantially in 2025. This module is based on NICE NG253 for people aged 16 or over who are not and have not recently been pregnant. Use current local antimicrobial, fluid, escalation and critical-care pathways, and check the live NICE guidance before patient-specific decisions.
Could this be sepsis?
Sepsis is a clinical syndrome arising from a dysregulated response to infection. The practical first step is not to wait for a perfect label: consider sepsis when infection is suspected or confirmed and there are new abnormalities of behaviour, circulation, respiration or other evidence of deterioration. A structured assessment should include history, examination, observations and attention to vulnerability factors. A normal-looking single observation does not exclude serious illness. Clinical concern, trajectory and response to initial treatment matter.
Risk evaluation and NEWS2
For adults in acute hospital settings, NICE NG253 uses NEWS2 as part of risk evaluation. NEWS2 must not be used mechanically. Clinical concern can raise the assessed risk above that suggested by the score alone, particularly with deterioration, poor response to treatment, mottled or ashen appearance, non-blanching rash or cyanosis. High-risk patients need urgent clinician assessment, repeated NEWS2 and prompt escalation. Moderate-risk patients also require timely review and reassessment. Evidence of hypoperfusion such as raised lactate or acute kidney injury should increase concern.
Early management principles
Management runs in parallel: assess severity, obtain appropriate investigations, start treatment when indicated, identify the likely source and escalate. In high-risk adults, NICE recommends broad-spectrum intravenous antibiotics within 1 hour of the initial NEWS2 assessment or ward deterioration if they have not already been given for that episode. For lower-risk groups, the guideline allows time for better diagnostic clarification in selected patients. This is not a licence to delay once the decision to give antibiotics has been made. Follow local antimicrobial guidance and seek senior/microbiology advice where needed.
Reassessment, source control and escalation
Repeated assessment is central. Recalculate NEWS2 according to risk and sooner if the patient deteriorates. Review response to fluids, oxygen, antimicrobial treatment and other interventions. Actively seek a source of infection and consider whether source control is required. Escalate promptly when physiology worsens, the diagnosis remains uncertain, there is organ dysfunction, or there is poor response to initial treatment.
