Date of Award

Spring 5-27-2023

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

Pedro Colio, Phd, DNP, FNP-C,ENP-C

Second Advisor

Joseph Burkard DNSc, CRNA, AACN

Abstract

Background: Sepsis is the cause of death of half of all admissions in the United States (Rhee, 2019). Medicare has adopted guidelines from the surviving sepsis campaign and labeled them the “The Severe Sepsis and Septic Shock Management Bundle (SEP-1) guideline to address the care required to try to reduce mortality involving septic patients. This bundle has an all or none feature that suggests every patient presenting with septic shock receives 30 ml/kg of normal saline as a bolus. (Medicare, 2021). One must document medical reason for not providing this bolus. Inferior vena cava point of care ultrasound (IVC POCUS) can help guide the decision to continue or withhold intravenous fluids (IVF). However, most advanced practiced practitioners (APPs) are not trained to perform POCUS exams. (Huang, 2022)

Project aim: The aim of this evidence-based practice project was to introduce the SEP-1 guideline and educate a group of APPs on the utilization of IVC POCUS to assess fluid status in an urban emergency department.

Approach/Method: This nurse practitioner led project focused on one-on-one (4-hour) training on the SEP-1 bundle and POCUS training. Pre- and post- intervention surveys were implemented to assess the utilization of this guideline along with self-reported POCUS competence.

Results: The results of this project demonstrated improved compliance of 85% with the SEP-1 guidelines and a 65% increase APP utilization of POCUS when determining IVF therapy among adult septic patients. Implementation of SEP-1 and POCUS training has a substantial return of investment (ROI) while improving patient outcomes. This project can be easily replicated in other emergency departments, improve provider medical-decision-making, and patient outcomes while meeting the SEP-1 standards of care.

Keywords: Sepsis, IV fluids, POCUS, Inferior vena cava compression.

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