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Creative Commons License
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ORCID

https://orcid.org/0000-0002-0179-4709

Date of Award

Fall 2018

Document Type

Dissertation

Degree Name

Doctor of Nursing Practice (DNP)

Department

School of Nursing

Advisor(s)

Linda J. Hulton

Betsy Herron

Frederick Villiard

Abstract

Purpose: Sepsis is one of the leading causes of mortality with over 700,000 hospitalizations and 200,000 deaths annually. Various tools exist to aid in the early identification and treatment of sepsis including electronic alert systems, standardized order sets, nurse-initiated protocols and specialty trained teams. Despite available guidelines, mortality rates for severe sepsis and septic shock are near 50%.

Methods: The aims of this rapid cycle quality improvement project were 1) to develop and implement an interdisciplinary team to address early implementation of evidence-based sepsis bundles in the emergency department and 2) to compare sepsis bundle compliance three months pre-and three months’ post-intervention implementation. The population included all patients’ over 18 years of age presenting to the emergency department with clinical indications of sepsis, severe sepsis, or septic shock.

Results: The pre-post intervention analysis shows an improvement in time to each bundle element except antibiotics. There was statistical significance in time to second lactate. Statistical significance was noted in the fluid resuscitation volume met (p=.000), initial lactate collected within 180 minutes (p=.001), and second lactate within 360 minutes (.000). Mortality rates in patients with sepsis on presentation showed a steady decline from 12.45% in the first month pre-intervention to 4.55% in the last month post intervention.

Conclusion: Interdisciplinary teams can utilize existing knowledge, skills and tools to improve sepsis bundle compliance and mortality outcomes in sepsis patients presenting to the emergency department.

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