Date of Award

Summer 2021

Document Type

Final DNP Paper

Degree Name

Doctor of Nursing Practice (DNP) in Adult-Gerontology Acute Care Nurse Practitioner



Faculty Chair

Dr. Melissa Duckett


Dr. Martha Richey


Sepsis is defined as a life-threatening organ dysfunction syndrome caused by a dysregulated host response to infection. Septic shock is defined as a subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities are associated with a higher risk of mortality than with sepsis alone. Each year, more than 1.7 million people are diagnosed with sepsis in the United States, and at least 270,000 Americans die. There is no confirmatory diagnostic test to diagnose sepsis. Therefore, clinical judgment based on evidence of infection and organ dysfunction is key.

Despite thousands of articles and hundreds of trials, sepsis plays a major role in mortality rates. The cornerstones of sepsis care continue to be early recognition, implementing an evidence-based care bundle, and prompt recognition and treatment implementation. The bundle approach has been encouraged since 2004. It endured major alterations over the years, emphasizing the time-critical aspect of sepsis and the need to restore tissue perfusion within one hour of presentation. A change from a three and six-hour bundle to a one-hour bundle has been recommended, but not without challenge. Despite healthcare professionals' efforts, the average national sepsis rate for meeting all measures is a mere 40%. As a quality improvement opportunity, moving toward an ideal state for improvement utilizes the evidence-based one-hour sepsis bundle with strict compliance of the sepsis order set while relying on the provider's expertise and training to diagnose and adequately treat the patient based on clinical findings and presentation. Staff were educated before, during, and after implementing the bundle to monitor compliance and trends.

This project was a departmental, retrospective, observational study of adult patients with a hospital discharge diagnosis of severe sepsis or septic shock. The study includes patients presented to the Emergency Department at a rural hospital facility between October 2020 to March 2021. The primary outcome of interest was the correlation between sepsis-bundle adherence and in-hospital length of stay.


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