Capstone excerpt
DNP Capstone Excerpt: A Nurse-Driven Sepsis Screening Protocol on Medical-Surgical Units
An excerpt from a DNP quality-improvement capstone implementing a nurse-driven sepsis screen, with a Plan-Do-Study-Act framework and outcome metrics.
Project Purpose and Framework
The purpose of this Doctor of Nursing Practice (DNP) project was to implement and evaluate a nurse-driven sepsis screening protocol on two adult medical-surgical units, where early sepsis recognition lagged behind that of monitored settings. Delayed recognition on general wards is a recognized failure point: each hour of delay in initiating appropriate antibiotics for septic shock is associated with a measurable increase in mortality (Seymour et al., 2017). The project was guided by the Plan-Do-Study-Act (PDSA) cycle nested within Lewin's change theory.
The intervention embedded a systemic inflammatory response and quick SOFA (qSOFA) screen into the electronic health record at every four-hour vital-sign entry. A positive screen triggered a structured nurse-to-provider communication using SBAR and initiated a sepsis order set, shifting the first recognition step from the provider to the bedside nurse.
Aim statement
By the end of the 12-week implementation period, this project aimed to increase the proportion of eligible patients screened for sepsis within four hours of a qualifying vital-sign change from a baseline of 41% to at least 85%, and to reduce median time-to-antibiotics for screen-positive patients.
Implementation Through PDSA Cycles
Three sequential PDSA cycles refined the protocol. Cycle one exposed alert fatigue from an over-sensitive trigger; the screen was recalibrated. Cycle two addressed a communication gap by scripting the SBAR escalation. Cycle three added a unit-based champion model so that adoption was sustained by peers rather than mandated from above — a deliberate application of Lewin's refreezing stage.
41% → 88%
Sepsis-screen completion within four hours, baseline to post-implementation
Sustainability planning positioned the protocol for spread beyond the pilot units. Recommendations included integrating screen-completion metrics into the unit quality dashboard and embedding the competency in annual skills validation, so the change survives staff turnover rather than depending on the original project team.