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Sepsis Symptoms and Management Policy

1. Policy Statement

Sepsis is a life-threatening condition that arises when the body’s response to an infection causes systemic inflammation and organ dysfunction. Early recognition and rapid response are critical to preventing severe illness or death.

As a domiciliary care provider, we are committed to early detection, prompt escalation, and appropriate management of sepsis cases in compliance with the latest Care Quality Commission (CQC) regulations. This policy ensures that our staff can identify sepsis symptoms, act swiftly, and escalate concerns appropriately to protect the well-being of service users.

This policy aligns with Regulation 12 (Safe Care and Treatment)​, ensuring that we take all practical steps to prevent and manage health emergencies effectively.

2. Purpose

The purpose of this policy is to:

• Ensure early identification and response to sepsis in service users.
• Standardise staff training and escalation procedures to provide a consistent approach.
• Comply with CQC Fundamental Standards, particularly Regulation 12 on safe care and treatment​.
• Safeguard service users by ensuring they receive prompt medical attention when sepsis is suspected.

3. Responsibilities

Registered Manager:

• Ensures that all care staff receive training on sepsis identification and management.
• Monitors compliance with this policy through spot checks, audits, and service user feedback.
• Ensures clear escalation procedures are in place.
• Liaises with healthcare professionals to ensure effective communication and prompt intervention.

Care Staff:

• Must be able to recognise early signs of sepsis.
• Follow the Sepsis Action Plan outlined in this policy.
• Immediately escalate concerns to emergency services and the registered manager.
• Keep accurate records of symptoms and actions taken.

Service Users & Families:

• Encouraged to be aware of sepsis symptoms.
• Support care staff in providing prompt medical intervention if necessary.

4. What is Sepsis?

Sepsis occurs when the body’s response to an infection causes widespread inflammation, leading to tissue damage, organ failure, and potentially death. It can develop from infections such as:

• Pneumonia
• Urinary tract infections (UTIs)
• Skin infections (e.g., cellulitis)
• Abdominal infections
• Wound infections

Service users in domiciliary care may be at higher risk due to:

• Weakened immune systems
• Chronic illnesses (e.g., diabetes, COPD, kidney disease)
• Recent surgeries or invasive procedures
• Use of catheters or feeding tubes
• Being elderly or frail

5. Recognising Sepsis Symptoms

5.1 Early Warning Signs (SEPSIS Screening)

Care staff should look out for the following symptoms, using the SEPSIS acronym for quick recognition:

• Slurred speech or confusion
• Extreme shivering or muscle pain
• Passing no urine (in a day)
• Severe breathlessness
• It feels like “I might die”
• Skin that’s mottled, discoloured, or bluish

If a service user exhibits one or more of these symptoms, staff must act immediately.

5.2 Sepsis in Older Adults

In elderly service users, symptoms may present differently:

• Sudden confusion or agitation
• Extreme fatigue or unresponsiveness
• A drop in body temperature (instead of fever)
• Worsening of existing conditions (e.g., increased breathlessness in COPD patients)

5.3 Sepsis in People with Learning Disabilities or Non-Verbal Service Users

Care staff must be extra vigilant in non-verbal service users:

• Sudden withdrawal or refusal to eat
• Rapid breathing or heart rate
• Fever or low body temperature
• Unusual skin colour (pale, blotchy, or bluish)

6. Sepsis Action Plan

If a care worker suspects sepsis, they must not delay action.

1. Recognise symptoms – Assess the service user using the SEPSIS screening tool.
2. Call 999 immediately – Explain that the service user has suspected sepsis.
3. Provide clear information to emergency responders, including:
   • The service user’s medical history.
   • Recent infections, wounds, or fevers.
   • Changes in mental state, breathing, or urine output.
4. Stay with the service user – Monitor their condition while awaiting emergency services.
5. Notify the Registered Manager immediately and record the incident in the organisation’s incident/accident reporting system without delay. Where required, the Registered Manager (or nominated person) must submit statutory notifications to CQC under the Care Quality Commission (Registration) Regulations 2009, including:

• Regulation 16 – Notification of death of a service user (where the death occurs during, or as a consequence of, the regulated activity), and/or
• Regulation 18 – Notification of other incidents (for notifiable events such as serious injury or other reportable incidents set out in the regulation).

6.1 Escalation thresholds (Domiciliary Care)

Care staff must escalate based on the service user’s presentation and immediate risk.

Call 999 immediately and state “suspected sepsis” where the person appears seriously unwell or has one or more red-flag symptoms, for example: new confusion, severe breathlessness, blue/mottled skin, collapse, seizures, or not passing urine for a prolonged period, or where the carer believes there is an immediate risk to life.

If the person is unwell with suspected infection but does not appear in immediate life-threatening danger, seek urgent same-day clinical assessment via the service user’s GP/urgent treatment service or NHS 111, and continue close monitoring until advice is received. If the person deteriorates at any point, escalate to 999.

Care staff must not delay escalation in order to complete paperwork or contact family members (unless required for access/consent and it is safe to do so). The priority is urgent clinical assessment.

7. Managing Sepsis Efficiently in a Domiciliary Setting

Staff Training & Awareness

• All staff receive mandatory training on sepsis recognition and escalation.
• Refresher training will be conducted annually and whenever guidelines change.
• Staff are required to demonstrate competence in identifying sepsis symptoms.

Communication with Healthcare Professionals

• Care staff must liaise with GPs, district nurses, and 999 services promptly.
• Ensure that service users have personalised care plans that highlight their risk factors for sepsis.

Monitoring High-Risk Service Users

• Service users with recent infections, urinary catheters, or chronic conditions should be closely monitored.
• Daily well-being checks must include observations within the care worker’s role and competence, such as level of alertness, breathing effort, skin colour, new confusion, fluid intake/output concerns, and any reported pain or “feeling very unwell”. Where staff are trained, competent and equipped (and it is within the commissioned care plan), basic observations such as temperature and respiratory rate should be taken and recorded, with prompt escalation of abnormal findings.

Emergency Planning

• Sepsis protocols are included in our Emergency Response Plan.
• Service users at high risk are identified in their care plans, with clear escalation pathways.

8. Reporting & Documentation

All suspected cases of sepsis must be reported and recorded accurately, including:

• Date and time of symptoms onset
• Actions taken (e.g., 999 call)
• Details of the emergency response
• Outcome (e.g., hospital admission, GP follow-up)

CQC notifications are only required where the sepsis incident meets statutory notification criteria. The Registered Manager (or nominated person) must notify CQC without delay in line with the Care Quality Commission (Registration) Regulations 2009, including:

• Regulation 16 – Notification of death of a service user (where applicable)
• Regulation 18 – Notification of other incidents (where the event is notifiable, for example a serious injury or other reportable incident listed in the regulation).

8.1 Duty of Candour (Regulation 20)

Where a sepsis event constitutes a notifiable safety incident, the Registered Manager (or delegated senior) will ensure the organisation meets the statutory Duty of Candour by:

• informing the service user and/or relevant person that the incident has occurred as soon as reasonably practicable,
• providing a truthful account of what is known at the time, including next steps and ongoing support,
• offering an apology, and
• keeping a clear written record of all Duty of Candour communications and actions taken.

9. Compliance with legislation and CQC Regulations

This policy supports compliance with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Fundamental Standards), including:

• Regulation 12 – Safe care and treatment: we assess risk, respond promptly to deterioration and escalate concerns to obtain urgent clinical support.
• Regulation 17 – Good governance: we maintain accurate contemporaneous records, investigate incidents, learn lessons, and audit compliance with this policy.
• Regulation 18 – Staffing: we deploy sufficient competent staff and ensure role-appropriate training/competency in recognising deterioration and escalating suspected sepsis.
• Regulation 20 – Duty of candour: where a notifiable safety incident occurs, we act openly and transparently with the service user and/or relevant person and keep appropriate records of that communication.

This policy also supports compliance with the Care Quality Commission (Registration) Regulations 2009 (statutory notifications), including:

• Regulation 16 – Notification of death of service user, and
• Regulation 18 – Notification of other incidents, where notification criteria are met.

10. Review & Policy Updates

This policy will be reviewed at least annually and sooner where there are changes to CQC guidance, statutory notification requirements, or updated national clinical guidance including NICE suspected sepsis guidance (NG253, NG254 and NG255), and relevant NHS guidance for recognising deterioration and sepsis. Any updates will be communicated to all staff through training sessions and written updates.

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