Adult warning words and deterioration

Adults with possible sepsis may say they feel extremely unwell without naming a specific problem. Family, carers or care-home staff may report sudden confusion, weakness, breathlessness, shivering or an abrupt change from the person’s usual state.

When the wording indicates deterioration, the contact should not be treated as a routine infection, fever or medication query. The urgent concern is the change in the person’s condition.

Listen or look for

• New confusion, slurred speech, drowsiness or not making sense.
• Severe breathlessness, fast breathing, blue lips or noisy breathing.
• Very cold, clammy, mottled skin or severe shivering.
• Not passed urine all day or a marked reduction in urine output.
• Too weak to stand, unable to drink, collapsing or rapidly worsening.
• Someone close to the patient saying they are not themselves or that something is seriously wrong.

Do not soften the wording

"Chest infection and now confused" is clearer and safer than "chest infection query". "Too weak to stand and not passed urine" conveys the urgency better than "unwell". Receiving clinicians or urgent services must see the concern plainly.

Repeat contact matters. If a patient calls again and is worse, more breathless, more confused or unable to drink, they should not be returned to a routine call-back or appointment queue.

Records detail

In adults, new confusion, severe weakness, breathlessness, reduced urine or a sudden change from normal should not be hidden inside a routine infection note.