Date of Conferral

2021

Degree

Doctor of Nursing Practice (DNP)

School

Nursing

Advisor

Cheryl Holly

Abstract

Sepsis, a life-threatening condition caused by infection, is a leading cause of mortality and morbidity globally. Researchers suggest that early identification of sepsis upon admission to the emergency department (ED) can help mitigate the consequences of sepsis. The emergency department of a hospital in a large urban U.S. city has participated in the Centers for Medicare & Medicaid Services’ sepsis reporting system (SEP-1) since 2015; however, recent reports indicated below benchmark scores. As more than half of patients diagnosed with sepsis were admitted or readmitted through the ED, the purpose of this project was to develop a clinical practice guideline, informed by Rosswurm and Larrabee’s evidence-based practice model and a literature search, for use in the ED with input from an expert advisory panel using the AGREE II tool criteria across six domains. A 4-member panel member, comprised of the ED’s medical director, director of nursing, nurse manager, and an ED staff nurse unanimously recommended the use of the guideline. Domain scores ranged from 40 to 100%, with a mean of 83%. This sepsis clinical guideline scored highest in the domains of scope and purpose (100%) and clarity and presentation (95%) and applicability (83%). The domains of stakeholder involvement (40%) and editorial independence (57%) had the lowest domain scores. The overall quality assessment score was 7 based on a Likert scale ranging from 1 (lowest possible quality) to 7 (highest possible quality). In making sepsis screening a routine practice informed by a clinical guideline, nurses at the project site may be able to identify sepsis earlier in patients presenting to the ED, resulting in improved outcomes, promoting a positive social change, and increasing the SEP-1 scores.

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