Importance of Initiating the Sepsis Six

Importance of Initiating the Sepsis Six

Septicaemia is an infection of the blood, the risk of which is higher in patients with increasing age and underlying health conditions involving the cardiovascular system, diabetes and any form of immunosuppression. Signs of Septicaemia include confusion, raised heart rate and respiratory rate. The patient will suffer from a temperature and will procedure less urine than normal. Prolonged exposure to Septicaemia can lead to respiratory, cardiac and renal failure.

There is an urgent timescale for treating Septicaemia so as to provide the best likelihood of a good prognosis and survival. In order to diagnose Septicaemia, the patient will require a full history and examination including blood tests to look for signs of infection, as well as an examination of urea and electrolytes to look at kidney function. Liver function and clotting tests should also be done and blood cultures taken. Imaging in the form of a chest x-ray should be undertaken. Once diagnosed, the Sepsis Six should be initiated. The Sepsis Six consists of three diagnostic and three therapeutic steps – all to be delivered within one hour of diagnosis of sepsis. They are as follows:

  1. Titrate oxygen to a saturation target of 94%.
  2. Take blood cultures and consider source control.
  3. Administer empiric intravenous antibiotics.
  4. Measure serial serum lactates.
  5. Start intravenous fluid resuscitation.
  6. Commence accurate urine output measurement.

It is imperative that if a patient shows signs of sepsis, they are managed aggressively using clinical sepsis bundles. They need to be nursed in an appropriate environment, for example a high dependency unit. Early recognition and early institution of fluids, oxygen, and antibiotics will give the patient the best chance of survival. If sepsis if not recognised, it will lead to multiple organ failure.


  • Written by The TMLEP Clinical Risk and Patient Safety Publishing Group, Ms Georgia Millington, Lead Divisional Analyst at TMLEP and Mr Barry Paraskeva, Consultant General, Colorectal and Laparoscopic . (2020). Importance of Initiating the Sepsis Six. TMLEP Clinical Risk Case Studies. 7 (3), 1.

Important Note

This article is intended to raise awareness to clinical risk issues in an effort to reduce incidence recurrence and improve patient safety. This is not intended to be relied upon as advice. Facts have been altered to ensure this case is non-identifiable, albeit clinical learning points remain applicable. To request an independent clinical review, please contact or call +44 (0) 203 355 9796.