Policy for the Management of Sepsis in Adults

Summary

The requester asked for the Sepsis Management Policy for Nobles Hospital and an explanation of the National Early Warning Score system. Manx Care provided the requested policies and confirmed the use of NEWS2, but redacted personal data from the documents citing an absolute exemption.

Key Facts

• Manx Care confirmed that the NEWS2 system is used in the hospital.
• NEWS2 has been in place since October 2023, replacing the original NEWS system used since 2014.
• NEWS2 is integrated into the Patientrack e-observation and Smart page paging systems.
• Personal data within the provided documents was redacted to comply with data protection principles.
• The response included 4 documents totaling 20 pages regarding the sepsis policy.

Data Disclosed

• October 2023
• 2014
• 4847349
• 20 pages
• 4 documents
• 2025-08-04
• 2025-08-20

Exemptions Cited

• Section 25 of the Act (absolutely exempt personal information)
• Article 5 of the General Data Protection Regulation
• Article 6 of the GDPR
• Article 9 of the GDPR

Original Request

Dear Sir or Madam I would be grateful if you could provide me with the Policy for the Management of Sepsis in Adults in respect of Nobles Hospital and the Island's emergency services. I wish to understand how staff within the hospital and the ambulance service screen for sepsis and also how an adult patient suspected of sepsis would be managed within Nobles Hospital. I am particularly interested in the policies in operation in the last 12 months. I believe they may have been updated but would like to see the old and new policy if it has been updated in the last year. Please can I also have an explanation as to how the National Early Warning Score (NEWS or NEWS2 system) is used in the hospital. Is it NEWS2? Thank you for your kind assistance.

Data Tables (13)

Full Response Text

Manx Care Noble’s Hospital, Strang Braddan, Isle of Man IM4 4R (01624) 650 000

Our ref: 4847349 19 August 2025

Dear

We write further to your request, received 4 August 2025, which states:

"Dear Sir or Madam

I would be grateful if you could provide me with the Policy for the Management of Sepsis in Adults in respect of Nobles Hospital and the Island's emergency services. I wish to understand how staff within the hospital and the ambulance service screen for sepsis and also how an adult patient suspected of sepsis would be managed within Nobles Hospital. I am particularly interested in the policies in operation in the last 12 months. I believe they may have been updated but would like to see the old and new policy if it has been updated in the last year.

Please can I also have an explanation as to how the National Early Warning Score (NEWS or NEWS2 system) is used in the hospital. Is it NEWS2?

Thank you for your kind assistance.

Response

While our aim is to provide information whenever possible, in this instance we are unable to provide some of the information you have requested because it is absolutely exempt under section 25 of the Act (absolutely exempt personal information).

The reasons why exemption s25(b)(i)&(ii) applies are that: • Manx Care is satisfied that the information amounts to personal data of which you are not the data subject; and • Manx Care is satisfied that disclosure of the information would contravene one of the data protection principles as set out at Article 5 of the General Data Protection Regulation as it applies in the Isle of Man pursuant to the Data Protection (Application of GDPR) Order 2018, namely that the Manx Care can only disclose the information where it would be fair, lawful and meet one of the conditions for lawful processing in Article 6 [or if you are dealing with sensitive personal data “and one of the conditions in Article 9 of the GDPR and Schedule 2 of the Implementing Regulations is met”] and in this case, none of those conditions have been met therefore names have been redacted.

1. I would be grateful if you could provide me with the Policy for the Management of Sepsis in Adults in respect of Nobles Hospital and the Island's emergency services. I wish to understand how staff within the hospital and the ambulance service screen for sepsis and also how an adult patient suspected of sepsis would be managed within Nobles Hospital. I am particularly interested in the policies in operation in the last 12 months. I believe they may have been updated but would like to see the old and new policy if it has been updated in the last year.

Please see attached documentation in regards to Sepsis request.

1. Please can I also have an explanation as to how the National Early Warning Score (NEWS or NEWS2 system) is used in the hospital. Is it NEWS2?

It is NEWS2 that is use and it has been in place since October 2023, in line with best practice (Royal College of Physicians, NHS) guidance. Prior to this, the original NEWS system was in use since 2014. As outlined in the policy, NEWS2 is integrated into the Patientrack e-observation, and Smart page paging systems, which enables clinicians to respond promptly to any significant deterioration in NEWS scores.

Please quote the reference number 4847349 in any future communications.

Your right to request a review

If you are unhappy with this response to your freedom of information request, you may ask us to carry out an internal review of the response, by completing a complaint form and submitting it electronically or by delivery/post.

An electronic version of our complaint form can be found by going to our website at https://services.gov.im/freedom-of-information/Review . If you would like a paper version of our complaint form to be sent to you by post, please contact me and I will be happy to arrange for this. Your review request should explain why you are dissatisfied with this response, and should be made as soon as practicable. We will respond as soon as the review has been concluded.

If you are not satisfied with the result of the review, you then have the right to appeal to the Information Commissioner for a decision on; 1. Whether we have responded to your request for information in accordance with Part 2 of the Freedom of Information Act 2015; or 2. Whether we are justified in refusing to give you the information requested.
In response to an application for review, the Information Commissioner may, at any time, attempt to resolve a matter by negotiation, conciliation, mediation or another form of alternative dispute resolution and will have regard to any outcome of this in making any subsequent decision. More detailed information on your right to a review can be found on the Information Commissioner’s website at www.inforights.im.

Should you have any queries concerning this letter, please do not hesitate to contact me. Further information about freedom of information requests can be found at www.gov.im/foi.

I will now close your request as of this date.

Yours sincerely

Hospitals Directorate (Isle of Man) Adult Sepsis Pathway

NEWS ≥ 5  Time of NEWS ≥ 5 :

Red Flag Sepsis Criteria (Tick all that apply) RR ≥ 25 breaths/min  ProCalcitonin ≥ 2.0  HR > 130 bpm  New need for Oxygen to maintain O2 Saturation ≥ 92%  ACVPU less than Alert (C, V, P or U)  Chemotherapy in last 6 weeks (Use Neutropenic Sepsis Pathway)  Systolic BP ≤ 90 mmHg
(Or drop of >40 mmHg from normal)  Not passed urine in last 18 hours (Or urine output less than 0.5ml/kg/hr)  Lactate ≥ 2  Skin: Non-blanching rash, mottled, ashen or cyanosed 

Sepsis Six (Within 1 hour) Time Completed : B Blood Cultures  Ideally before antibiotics Also request urgent bloods U Urine Output  Record fluid balance (consider catheter) F Fluids (IV)  At least 20ml/kg of crystalloid as 500ml STAT boluses even if BP is normal (caution in heart failure) A Antibiotics (IV)  As per antibiotic formulary (consider allergies) Consider source control or urgent referral for it L Lactate  Measure initially and repeat after IV fluids O Oxygen  Target O2 Saturation: 94 – 98% (For CO2 Retainer: 88 – 92%)

[ Affix Patient Label Here ] SEPSIS PATHWAY YES 
Manage Appropriately Consider other factors that increase risk of sepsis MAP ≤ 65 mmHg OR Repeat Lactate ≥ 2 despite IV fluids?  Senior Review (ST3+) within 2 hours Suspected Septic Shock If appropriate, consider Anaesthetist Review YES 
 NO Sepsis
Continue to Manage Appropriately Doctor: Signature: Date & Time: At least 1 Red Flag AND Infection Suspected?  NO HOSPITALS DIRECTORATE ADULT SEPSIS PATHWAY

PAGE 1 OF 2 Supporting Information: Adult Sepsis Pathway

Sepsis: A life-threatening condition that arise when the body’s response to an infection injures its own tissues and organs.

Suspected Infection: Assess patients for signs and symptoms, based on history and examination, to identify the possible source of infection. A patient cannot have sepsis without a suspected infection.

Other Factors that Increase Risk of Sepsis:

• Relatives concerned about mental status

● Immunosuppressed / Diabetes • Acute deterioration in functional ability

● Respiratory Rate 21 – 24
• Trauma / Surgery / Procedure in last 6 weeks ● Systolic BP 91 – 100 • Heart rate 91 – 130 or new dysrhythmia

● Temperature <36.0°C • Clinical signs of wound, device or skin infection ● Anuria in last 12 – 18 hours

Patients with sepsis must have urgent bloods (FBC, U&E, CRP, LFTs, Clotting and Lactate). Patients who have at least 2 of the above factors that increase the risk of sepsis, should also have these urgent bloods if an infection is suspected. If the bloods show organ dysfunction (e.g. AKI), they need Sepsis Six within 3 hours.

Examples of sources of infection:

• Pneumonia / lower respiratory tract

● Skin / Soft tissue / Wound • Urinary Tract / Catheter

● Female Reproductive Tract • Intra-abdominal / Peritonitis

● CNS / Meningitis • Biliary Tract

● Bone / Joint • Foreign body (e.g. tampon)

● Endocarditis • Blood stream (e.g. indwelling lines)

● ENT / Dental

Specimen Culture: Take appropriate specimen samples for culture e.g. urine, sputum, wound & CSF.

Radiology: Consider appropriate radiological imaging, once all of the Sepsis Six have been commenced.

Intravenous Antibiotic Formulary (Only for Sepsis)

• Review the most recent microbiology results to see if a more resistant organism (e.g. ESBL producer, CPE and MRSA) is present, as it might not respond to the suggested antibiotic. • Always adjust antibiotic dose and/or frequency in renal impairment as per BNF or antimicrobial formulary. For example, Gentamicin dose is usually 5mg/kg (max 460mg) but the dose needs adjusting in renal impairment as per the antimicrobial formulary.

Infection Recommendation Alternative/Comments Community Acquired Pneumonia (CAP) Co-amoxiclav 1.2g 8 hourly + Clarithromycin 500mg 12 hourly Refer to antimicrobial formulary for alternative antibiotics and for other types of Pneumonia. Urinary Tract Piperacillin / Tazobactam (Tazocin) 4.5g 8 hourly Ciprofloxacin 400mg 12 hourly + Gentamicin 5mg/kg once daily dosing Intra-abdominal Or Biliary Tract Co-amoxiclav 1.2g 8 hourly + Gentamicin 5mg/kg as a single dose Ciprofloxacin 400mg 12 hourly + Metronidazole 500mg 8 hourly + Gentamicin 5mg/kg as a single dose Cellulitis

Flucloxacillin 1g 6 hourly
(No history of MRSA infection / colonisation) Teicoplanin 400mg 12 hourly for first 3 doses then OD.
(Increase dose in severe infections) Unknown Source Give antibiotics based on the most likely source of infection. Other Sources For other infections (e.g. meningitis), refer to antimicrobial formulary.

Date of Issue: Oct 2017 Date Reviewed: July 2019 Ratified: Jun 2019 HOSPITALS DIRECTORATE ADULT SEPSIS PATHWAY

PAGE 2 OF 2

Hospitals Directorate

Policy for the Management of Sepsis in Adults

1. Purpose 1.1. To ensure that all patients with possible sepsis are managed according to evidence based protocols. Sepsis and Septic shock have significant morbidity and mortality rates which increase further when not initially recognised. Reader Information

Title

Hospitals Directorate Policy for the Management of Sepsis in Adults

Author / Contact Details

Publication Date

December 2018

Target Audience

All Hospitals Directorate Staff who are involved in caring for patients aged 16 years and above

Description

This policy describes the actions which must be taken by any staff member who may be involved in the care of any patient aged 16 years and above who may have sepsis. There is a separate pathway for children under the age of 16.

Changes

The new sepsis criteria were introduced in October 2017. Neutropaenic Sepsis became a stand-alone policy in 2019. Maternal Sepsis is also a separate, stand-alone Policy.

Cross Reference

Noble’s Hospital Adult National Early Warning Score Policy 136/2015 Sepsis pathway 2017 (Appendix 1) Neutropaenic sepsis Policy 2018 Maternal Sepsis Policy Noble’s Hospital Antimicrobial Policy Oct 2017

Superseded Documents

0012/April 2014 Management of Sepsis in Adults

Author:

Date: Feb 2019 Review Date: Feb 2020

1.2. This document aims to raise awareness of sepsis amongst healthcare professionals in order to ensure patients who may have sepsis are recognised and appropriate treatment is initiated without unnecessary delay. 1.3. This protocol is for use by all clinical staff involved in the care of adult patients. 1.4. This protocol covers the initial recognition and management of sepsis syndromes in adult patients aged 16 years and above. 1.5. This policy makes the use of the Sepsis Pathway mandatory for all clinical staff at Noble’s Hospital whenever sepsis is a possible diagnosis in those patients who fulfil the inclusion criteria. The Sepsis Pathway was developed by a working group consisting of Intensivists, EM clinicians, and Physicians. This will be reviewed at regular intervals along with this Policy. 1.6. This protocol excludes all children aged 15 years and below. 1.7. This protocol excludes any patient suspected of neutropaenic sepsis. 1.7.1. For suspected neutropaenic sepsis, the Neutropaenic Sepsis Policy must be followed. 1.7.2. Neutropaenic sepsis should be suspected in any patient who might have a white cell count <1.0 x 109. This includes any oncology patient within 6 weeks of systemic anti-cancer treatment and any haemato-oncology patient irrespective of treatment status. 1.7.3. Neutropaenic patients are at very high risk of sepsis and may not show the usual signs associated with sepsis. 1.8. This protocol excludes Maternity patients. 1.8.1. For maternity patients, please follow the maternal sepsis policy. 1.8.2. Maternal sepsis is a life-threatening condition defined as organ dysfunction resulting from infection during pregnancy, childbirth, post-abortion, or post-partum period.
2. Definitions 2.1. The early recognition of, and protocol driven initial management of sepsis, have been shown to improve outcomes of this potentially fatal condition. In some individuals, deterioration is rapid over a period of hours whereas others deteriorate more slowly over days. 2.2. The SIRS (Systemic Inflammatory Response Syndrome) criteria have been abandoned in favour of red flag signs and symptoms and a simpler screening tool has been introduced. A distinction is made between neutropaenic and non-neutropaenic patients.
2.3. Sepsis is defined as a life threatening condition which arises when the body’s response to an infection injures its own tissues and organs. A patient cannot have sepsis without a suspected infection.
2.4. Septic shock is a more serious subset of sepsis and is characterised by a Mean Arterial Pressure ≤65mmHg despite fluids or a persisting lactate ≥2.0 when rechecked after a fluid bolus. Patients Author:

Date: Feb 2019 Review Date: Feb 2020

with suspected septic shock may require escalation of care to HDU, and therefore consideration should be given to an Anaesthetic or CCOT (Critical Care Outreach Team) review.
2.5. Sources of infection are included on the Sepsis proforma and include Respiratory Tract, Urinary Tract, Gastrointestinal, Central Nervous System, Skin, Blood, Genital Tract, Bone, Foreign Body, Cardiac, ENT and Maxillofacial. This list is not exhaustive. 2.6. The Red Flag criter

[Response truncated — full text is 32,213 characters]