Date of Award

2023

Document Type

Project

College/School

College of Nursing

Degree Name

Doctor of Nursing Practice (DNP)

Project Mentor

Diane F Switzer

Readers

Benjamin J Miller

Abstract

Sepsis is a leading cause of morbidity and mortality worldwide. Treatment depends on time-sensitive antibiotic initiation, fluid resuscitation, and vasoactive support. Early recognition and bundled care are core tenets of management. Thus, this project aims to identify barriers to sepsis bundle compliance in a local community emergency department. Specifically, how do perceived barriers to sepsis bundle compliance as identified by staff correspond with quantitative delays in care as demonstrated by chart data? This mixed-methods needs assessment consists of staff surveys and analysis of extracted chart data. Staff surveys revealed barriers including staffing shortages, difficulty with intravenous (IV) access, and lack of recognition in triage. Case reviews showed that many patients receive components of the 1-hour sepsis bundle before they screen SIRS+ (57% of patients for lactate draws, 34% of patients for blood culture draws, n=35). Across cases, average door-to-antibiotic time was 137.06 minutes (SD 88.66 minutes). Thus, the department has yet to meet its target of door-to-antibiotic time less than one hour. Survey data and case reviews provide a launchpad for future quality improvement (QI) initiatives in the emergency department.

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