Date of Graduation

Fall 12-15-2023

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)


School of Nursing and Health Professions


MSN project

First Advisor

Nneka Chukwu, DNP-HCSL, MBA, RN, CLNC, CNL


Problem: This quality improvement (QI) project aims to optimize early sepsis management and sepsis bundle compliance among Emergency Department (ED) registered nurses in order to reduce the risk of sepsis-related deaths and associated hospital length of stay.

Context: Clinical Nurse Leader (CNL) students conducted a microsystem assessment on the ED at Hospital A, located within the greater San Francisco Bay Area. This microsystem, equipped with 115 nurses and 44 rooms, consists of an acuity of care for urgent to life-threatening medical conditions, including sepsis.

Intervention: Following time constraints, and limitations, implementation of an intervention was not feasible; however, CNL students provided recommendations so stakeholders may further investigate and pursue. The recommended interventions include: increasing sepsis bundle training frequency, refining intravenous placement skills through technologically driven training and readily available resources, badge buddy sepsis cards, and revision of the current charting system.

Measures: CNL students collected data to assess the nurses' knowledge of the sepsis bundle and Hospital A’s sepsis policy. The data also served to identify frequency of training, debriefings, and any barriers nurses experienced while implementing the bundle. Due to time constraints, a post-intervention survey was not conducted.

Results: 41 of the 115 ED registered nurses responded. Pre-intervention questionnaire responses revealed that 42% of ED nursing staff recommend protocol revision, 24.4% claim to not have attended any sepsis training with another 4.9% reporting rarely attending, and 46.3% reported there is no debriefing, or follow-up training, when sepsis bundle compliance is failed to be met. Additionally, nurses identified various barriers, prolonging sepsis bundle compliance.

Conclusions: Analysis of the pre-intervention questionnaire responses from Hospital A’s ED registered nurses revealed knowledge gaps and barriers to timely sepsis management and bundle compliance. CNL students identified evidence-based recommendations, which stakeholders may implement to yield anticipated outcomes.

Keywords: sepsis, sepsis management, sepsis bundle, sepsis bundle compliance, SIRS, emergency department, and quality improvement