Practice Tip of the Week | Early Identification and Treatment of Sepsis on Inpatient Units

By Jenny Kelly, DNP, RN and Wellington Mhango, RN, BSN, in partnership with the Texas Nurses Association Nursing Practice Committee 

Sepsis, a life-threatening response to an infection, is a medical emergency and one of the leading causes of death and disability in the United States (Centers for Disease Control and Prevention (CDC), 2022). Approximately 1.7 million individuals in the United States develop sepsis annually. Of that number, approximately 270,000 will die from sepsis. Sepsis accounts for one out of every three deaths in the hospital setting. Sepsis is one of the leading causes of death, disability, and health care costs in the United States (Buchman et al., 2018; Rhee et al., 2019). Each year, sepsis strikes approximately two million people in the United States and has a daily price tag of approximately $55.6 million (Buchman et al., 2018). The global healthcare cost for sepsis is roughly $17 billion dollars (Paioli et al., 2018). 

These alarming statistics have prompted hospitals and regulatory bodies to invest heavily in improving sepsis recognition and care. For the last several years, sepsis research has focused on best practices for treating patients with sepsis. The timing of sepsis recognition is critical in terms of outcomes given the acute and significant impact of the condition (Paioli et al., 2018). Poor sepsis outcomes are observed when the recognition and treatment of sepsis are delayed (Whiles et al., 2017). Each hour antibiotics are delayed increases mortality by 0.3 to 1.8% (Liu et al., 2017). According to the Society of Critical Care Medicine [SCCM] (2021), patients diagnosed with sepsis admitted to hospital general inpatient units have a higher risk of death. Delays in recognition and early treatment have been associated with worse patient outcomes (SCCM, 2021).  

TIPS FOR EARLY RECOGNITION OF SEPSIS 

When assessing patients, use the S.E.P.S.I.S. acronym (MedStar Health, 2024). 

S – sleepiness/confusion 

E – excessive discomfort or pain 

P – pale, discolored, clammy, or sweaty skin 

S – shortness of breath 

I – I feel like I might die (subjective patient data) 

S – suspected or known infection (abdominal pain, nausea, vomiting, cough, fever, wound, etc.) 

Another helpful acronym is T.I.M.E. (Myers, 2024).  

T – temperature 

I – infection 

M – mental decline 

E – extremely ill 

Consider changes in cardiovascular, respiratory, and urinary status as potential for sepsis:

• High heart rates, weak pulses, low blood pressure, sweaty/clammy skin 
• Increased work of breathing, shallow respirations, shortness of breath 
• Decreased urinary output 

Notify the physician and follow hospital guidelines for sepsis alerts immediately upon suspicion of sepsis. 

TIPS FOR RECOGNIZING VULNERABLE POPULATIONS 

Recognizing these symptoms in vulnerable populations is also important. Vulnerable populations include: 

• Older adults (65 and older) 
• Pregnant women 
• Immune-compromised individuals 
• People with chronic illness 
• Children (under 1 year of age) 
• Those with recent experience of sepsis  

Mild presentation of sepsis symptoms has led people to delay seeking treatment, especially in vulnerable populations (Rudd et al., 2025). It is imperative to educate patients to look out for warning signs and seek medical attention immediately. Some example tips of warning sign include secondary emergence of symptoms after a leg wound e.g, redness, pain, and feeling hot, warrants seeking medical attention immediately. Another missed warning sign is, emerging of secondary symptoms after finishing the course of oral antibiotic at home. 

TIPS FOR COMPLETION OF THE ONE HOUR SEPSIS BUNDLE 

1. Use a standardized checklist to track initiation and completion of bundle elements. 
2. REMEMBER: collect blood cultures BEFORE antibiotic administration. 
3. Ask the physician to consider an intramuscular antibiotic administration. 
4. Use the alarm feature on a phone or other electronic device to set reminders for when the next element of the bundle is due.
5. Repeat lactic acid specimen collection can be performed after the completion of the first fluid bolus (i.e. after the first “bag” of fluids). 

It is important to recognize early signs and symptoms to prevent poor outcomes in the community. Nurses have an important task in educating their patients as they discharge them home so they can make life-saving decisions before conditions deteriorate. 

REFERENCES

Buchman, T. G., Simpson, S. Q., Sciarretta, K. L., Finne, K. P., Sowers, N., Collier, M., Chavan, S., Oke, I., Pennini, M. E., Santhosh, A., Wax, M., Woodbury, R., Chu, S., Merkeley, T. G., Disbrow, G. L., Bright, R. A., MaCurdy, T. E., & Kelman, J. A. (2020). Sepsis among medicare beneficiaries: 1. The burdens of sepsis, 2012-2018. Critical Care Medicine, 48(3), 276–288. https://doi.org/10.1097/CCM.0000000000004224

Centers for Disease Control and Prevention. (2022). Sepsis. https://www.cdc.gov/sepsis/what-is- sepsis.html#anchor_1547213983

Liu, V. X., Fielding-Singh, V., Greene, J. D., Baker, J. M., Iwashyna, T. J., Bhattacharya, J., & Escobar, G. J. (2017). The timing of early antibiotics and hospital mortality in sepsis. American Journal of Respiratory and Critical Care Medicine, 196(7), 856–863. https://doi.org/10.1164/rccm.201609-1848OC

MedStar Health. (2024). Know the signs and symptoms of sepsis. https://www.youtube.com/watch?v=1LGGVHg52-A&t=53s

Myers, M. (2024). Consider T.I.M.E. when dealing with sepsis. Mayo Clinic Health System. https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/consider-time-when-dealing-with-sepsis#:~:text=The%20acronym%20T.I.M.E.%20is%20a,severe%20sepsis%20or%20septic%20shock.

Paioli, C. J., Reynolds, M. A., Sinha, M., Gitlin, M., Crouser, E., (2018). Epidemiology and costs of sepsis in the United States-An analysis based on timing of diagnosis and severity level. Journal of Critical Care Medicine 46(12). doi: 10.1907/ccm.000000000000003342

Rhee, C., Jones, T. M., Hamad, Y., Pande, A., Varnon, J., O’Brien, C., Anderson, D. J., Warren, D. K., Dantes, R., B., Epstein, L., & Klompas, M. (2019)., Prevalence, underlying causes, and preventability of sepsis-associated mortality in US acute care hospitals. Journal of the American Medical Association. 2(2):e187571. doi:10.1001/jamanetworkopen.2018.7571

Rudd, K. E., Randolph, A. G., Angus, D. C., Bauer, M., Chesley, C. F., Filbin, M. R., Jenq, G., Kempker, J. A., Levine, A. C., Levy, P., Machado, F. R., Mohr, N. M., Quinn, R., Rowan, K., Shankar-Hari, M., Sheikh, F., Sleboda, P., Teichman, J. S., Calandra, T., & Prescott, H. C. (2025). Preventing, identifying, and managing sepsis in the community: research and clinical priorities. The Lancet Primary Care, 100010. https://doi.org/10.1016/j.lanprc.2025.100010

Society of Critical Care Medicine. (2021). Surviving sepsis campaign releases 2021 adult sepsis guidelines.  https://www.sccm.org/Clinical-Resources/Guidelines/Guidelines/Surviving-Sepsis-Guidelines-2021

Whiles, B. B., Deis A. S., & Simpson, S. Q., (2017). Increased time to initial antimicrobial administration is associated with progression to septic shock in severe sepsis patients. Journal of Critical Care Medicine, 45(1), 623-629. doi: 10.1097/CCM.0000000000002262

World Health Organization. (2024, May 3). Sepsis. https://www.who.int.newsroom/fact-sheet/detail/sepsis