Date of Award

Fall 2019

Degree Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)

School

Leadership and Advanced Nursing Practice

Committee Chair

Michong Rayborn

Committee Chair School

Leadership and Advanced Nursing Practice

Committee Member 2

Nina Mclain

Committee Member 2 School

Leadership and Advanced Nursing Practice

Abstract

Through a systematic review of data, a clinical affiliate hospital in south Mississippi identified opportunities to improve their treatment of adult patients presenting with or developing sepsis. In response, the facility initiated an ongoing quality improvement program to revise their management of patients meeting sepsis and septic shock criteria, which included elements of the 2012 Surviving Sepsis Campaign (SSC) guidelines. The purpose of this Doctor of Nursing Practice (DNP) project was to determine the current best practice recommendations for early adult sepsis management to assist with the implementation of an evidence-based adult sepsis guideline.

The reviewed literature reported that the current best practice recommendations for early management of adult patients with sepsis include: (a) measurement of a serum lactate level within one hour of sepsis recognition and revaluation if the initial lactate level is >2 millimoles per liter (mmol/L); (b) obtaining blood cultures prior to the administration of antibiotic therapy; (c) administration of broad-spectrum antibiotics within one hour sepsis recognition; (e) rapid administration of 30 milliliters per kilogram (mL/kg) of intravenous (IV) crystalloid within one hour of sepsis recognition associated with hypotension or serum lactate > 4 mmol/L; and (f) administration of vasopressors for hypotension during or after the initial fluid resuscitation to maintain a mean arterial pressure (MAP) > 65 mmHg (Lester, Hartjes, & Bennett, 2018; Levy, Evans, & Rhodes, 2018; Rhodes et al., 2017). The best practice recommendations were presented to a panel of experts including (a) two Acute Care Nurse Practitioners (ACNPs), (b) two Emergency Department (ED) physicians, and (d) two Certified Registered Nurse Anesthetists (CRNA) at the facility where this project was conducted. Sixty-six percent of the panel of experts strongly agreed that the information provided was beneficial and relevant to their institution. Additionally, 66% of the panel was provided with new information for the management of adult patients with sepsis based on the best practice recommendation presented. Each member of the panel of experts agreed the best practice recommendations should be adopted.

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