Exam Pass Notes

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Use these notes to focus your revision before the final assessment. The exam assesses recognition of infection-related deterioration and appropriate escalation, not clinical prescribing or hospital treatments.

Core messages

• Sepsis is life-threatening: it is the body's harmful response to infection and requires urgent clinical assessment and treatment.
• Care staff do not diagnose sepsis: their role is to identify possible infection with deterioration and escalate without delay.
• Think "could this be sepsis?": especially when a resident with signs of infection becomes newly confused, breathless, drowsy, mottled, weak, cold, clammy or passes less urine.
• Fever is not required: older, frail or immunosuppressed residents may not develop a high temperature.
• Baseline matters: new changes in behaviour, mental state or function can be significant, particularly in people with dementia or learning disabilities.
• Common sources: chest, urinary tract, skin and wounds, abdomen, pressure ulcers, surgical sites, catheters and other devices.
• Higher-risk residents: age 75 or over, frailty, multiple conditions, impaired immune function, recent surgery or invasive procedures, catheters, repeated antibiotics, broken skin and communication barriers.
• Urgent red flags: severe breathlessness, very fast breathing, blue or grey colouring, mottled or ashen skin, non-blanching rash, new severe confusion, difficult-to-wake presentation, very low blood pressure if measured, or little-to-no urine output for a worrying period.
• Use observations if trained: temperature, pulse, respiratory rate, blood pressure, oxygen saturation, consciousness, urine output and skin signs all inform escalation decisions.
• Do not delay emergency help: observation tools support escalation but must not slow action when a resident is seriously unwell.
• Say the concern clearly: "I am worried about possible sepsis" is an appropriate phrase when you suspect it.
• Keep monitoring: residents can deteriorate while waiting for advice, review or transport.

Useful handover structure

• Situation: what is happening now and why you are worried.
• Background: diagnoses, baseline function, likely infection source, recent surgery, catheters, wounds, medicines and advance plans.
• Assessment: observations, behaviour change, urine output, skin signs, breathing, mental state and any trends.
• Recommendation: the help you need, such as urgent review, 999 transfer or clear safety-netting advice.
• Decision: what was agreed, who is responsible, when review will happen and actions if the resident worsens.

For the exam, remember: infection plus deterioration should trigger action. Trust your knowledge of the resident's baseline, escalate clearly and do not wait for every possible sign to appear.