Escalating urgent concern and calling for help

Sepsis escalation is about acting quickly. If a resident may have an infection and is showing serious deterioration, staff must escalate using local protocols and call emergency services if the situation is life-threatening.

Use the right route for the level of concern

• Call 999 immediately: if the resident has red flags, severe breathlessness, collapse, blue or grey colour, non-blanching rash, severe confusion, difficulty to rouse, very low blood pressure if measured, or you judge this to be an emergency.
• Seek urgent clinical advice: if there is possible infection plus new deterioration, moderately abnormal observations, reduced urine output, new functional decline or strong staff or family concern.
• Use local pathways: follow your service's process for GP, out-of-hours GP, community nursing, 111, urgent response, ambulance or senior nurse review.
• Say the concern clearly: if you are worried about sepsis, use the word "sepsis" when you call.
• Keep monitoring: repeat observations as trained and appropriate, and call again if the resident worsens while you wait.

Advance care plans, DNACPR decisions or treatment escalation plans do not mean "do nothing". A deteriorating resident still needs prompt senior or clinical review so the team can agree appropriate treatment, comfort measures or transfer.

If the resident is getting worse, escalate again. Waiting for a previous callback is not a safety plan.