Date of Graduation

Summer 8-7-2018

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)


School of Nursing and Health Professions

First Advisor

Nancy Taquino, DNP, RN, CNL

Second Advisor

Elena Capella, EdD, MSN/MPA, RN, CNL, CPHQ, LNCC


Problem: The aim of this project is to improve intermediate sepsis bundle performance with a primary focus on repeat lactate within 6 hours of arrival in the ED. One of the most significant problems we are facing today in healthcare, with an incidence of 300 to more than 1,000 cases per 100,000 persons annually in the United States, is severe sepsis (Gaieski, Edwards, Kalian, & Carr, 2013).

Context: Multiple studies have shown a strong correlation in reducing hospital and 30-day mortality by implementing process-oriented bundle for patients with sepsis and intermediate lactate values in accordance with the Surviving Sepsis Campaign guidelines. The site for this quality improvement project is a not-for-profit, medium-sized, tertiary hospital serving the San Joaquin and Stanislaus county communities. The improvement team comprised of a CNL student, physician champions, unit nurse champions, educators, and staff champions from lab, radiology, and pharmacy.

Interventions: The interventions for this project include developing a sepsis screening tool to help frontline nurses recognize early signs of sepsis, developing a standardized process between lab and nursing for repeat lactate orders, implementing the sepsis clock tool which outlines timely appropriate treatment based on clinical guidelines for patients diagnosed with sepsis, and implement a sepsis alert protocol to activate early and appropriate interventions.

Measures: Family of measures include an outcome measure (increase sepsis bundle compliance for intermediate lactate), 4 process measures (lactate drawn within 1 hr, antibiotic within 3 hrs, fluids within 3 hrs, and repeat lactate drawn within 6 hrs), and one balancing measure (increase in workload for lab staff causing delay in completing other lab orders).

Results: Intermediate Lactate Bundle compliance showed improvement from initiation of the project and performance is above the target of 55% for the past three months.

Conclusion: Results show that use of a screening tool to help identify early signs of sepsis as well as use of sepsis time reminder tool to help staff keep track of specific timelines increased compliance with the sepsis intermediate lactate bundle.

Included in

Nursing Commons