Graduation Semester and Year
Fall 2026
Language
English
Document Type
DNP Project
Degree Name
Doctor of Nursing Practice
Department
Nursing
First Advisor
Dr. Michelle Hampton
Abstract
Background: Sepsis is the leading cause of death in U.S. hospitals, accounting for one in three deaths. A one-hour delay in sepsis care increases the risk of death by 4-9%. In 2015, the Centers for Medicare & Medicaid Services (CMS) adopted the Severe Sepsis and Septic Shock Early Management (SEP-1) bundle to reduce delays in sepsis care.
Objectives: SEP-1 compliance remains below 60% despite CMS adopting the SEP-1 bundle. This evidence-based quality improvement project aimed to increase SEP-1 compliance to improve mortality and length of stay.
Method: A nurse trained in sepsis care assessed patients admitted to the 37-bed medical-surgical unit to identify those admitted with sepsis or suspected sepsis and to evaluate SEP-1 bundle measure compliance. The nurse reviewed provider notes, orders, medication administration records, and lab results to ensure appropriate SEP-1 bundle orders and timely implementation. The nurse notified attending physicians of any fallouts and requested SEP-1 bundle orders. The project spanned eight weeks.
Results: The project included 170 patients: 71 in the pre-intervention period and 46 in the intervention period. The intervention increased SEP-1 compliance by 11.3 percentage points, from 64.8% to 76.1%. Improvements in lactate testing (81.7% to 89.1%), fluid resuscitation (79.9% to 89.1%), and mortality (9.9% to 6.5%) were also observed.
Conclusion: Improving SEP-1 compliance through a nurse-driven sepsis protocol improved clinical outcomes. These findings underscore the important role nurses play in advancing quality improvement initiatives.
Keywords: Sepsis, SEP-1, Quality Improvement, nursing protocol, sepsis bundle, lactate, fluid resuscitation, antibiotic administration.
Keywords
SEP-1, Sepsis, SIRS, Mortality, Readmission, Nurse led protocols, Readmission, Mortality, Length of stay, Antibiotic, Lactate
Disciplines
Critical Care Nursing
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Recommended Citation
Casas, Miguel T., "Sep-1 Bundle Compliance in Hospitalized Patients 18 Years and Older" (2026). Doctor of Nursing Practice (DNP) Scholarly Projects. 36.
https://mavmatrix.uta.edu/nursing_dnpprojects2/36
Comments
This is an acknowledgement to my faculty advisor Michell Hampton RN, Ph.D.