DNP Scholarly Projects


Sepsis, a life-threatening infection killing 270,000 yearly, is a concern to health care providers, policy makers, and patients due to its high volume and increasing cost. Patients older than 64 years have a higher occurrence of sepsis and greater mortality risk. The Surviving Sepsis Guidelines (SSG) recommends the use of the three-hour bundle that standardizes care to decrease cost, morbidity, and mortality. The three-hour bundle includes two treatments, intravenous fluids and antibiotics, and two tests, blood cultures and lactic acid level. One bundle element, lactic acid level, is associated with higher mortality rates, although only a few studies exist. The project purpose was to compare the influence of the three-hour sepsis bundle completion and the initial lactic acid level on mortality rates in adults in an emergency department over a two-year period. The Donabedian quality of care framework guided the project related to structure, process, and outcome. Analysis of data from a retrospective chart review of 341 charts determined the association between three-hour sepsis bundle compliance and mortality rates. Individuals who received the three-hour bundle elements had lowered mortality rates and those with higher lactic acid had increased odds of mortality. There was no significance between mortality rates of older individuals who received the three-hour bundle elements and those who did not. The findings of this project confirm completing the three-hour bundle and improving current processes in a specific emergency room positively impact mortality rate.



First Advisor

Dr. Linda Wofford

Scholarly Project Team Member

Dr. Erin Shankel

Scholarly Project Team Member

Dr. David Phillippi


Nursing, School of


Health Sciences & Nursing, Gordon E. Inman College of

Document Type

Scholarly Project


Doctorate of Nursing Practice (DNP)

Degree Level


Degree Grantor

Belmont University


three-hour sepsis bundle, lactic acid, mortality rate, emergency department