Characteristics, Implementation and Effects of Nurse‐Driven Sepsis Protocols in Hospital Settings: A Systematic Review
Alethea Ray See Li, Marcia Jia Jia Sim, Jasmine Su Ying Lim, Jian Zhi Tan, Ee Ling Goh, Wei Ling ChuaABSTRACT
Aims
To synthesize evidence on the characteristics, implementation and effects of nurse‐driven sepsis protocols on process‐of‐care indicators and clinical outcomes.
Design
Systematic review without meta‐analysis.
Methods
Studies were included if they described and evaluated nurse‐driven sepsis protocols in hospitals. Two reviewers independently screened titles, abstracts and full texts for eligibility. The Johns Hopkins Nursing Evidence‐Based Practice model was used to appraise included studies. Data were extracted and narratively synthesized.
Data Sources
Eight databases were searched from database inception to 30 June 2025.
Results
Fifteen studies were included, most using before‐and‐after designs and conducted in the emergency departments ( n = 7) and hospital‐wide settings ( n = 4). Protocols commonly used systemic inflammatory response syndrome criteria for screening ( n = 12) and incorporated key Surviving Sepsis Campaign recommendations ( n = 14). Most studies reported improved or comparable outcomes to baseline in overall sepsis bundle compliance and key process‐of‐care indicators, including timely antibiotic administration, blood culture collection, lactate measurement and fluid administration. All 11 studies evaluating mortality reported reductions, although only four were statistically significant. Findings for hospital length of stay were inconsistent. Common implementation strategies included nurse education and training, coupled with audit and feedback.
Conclusions
Nurse‐driven sepsis protocols may improve adherence to and timeliness of key sepsis care processes. Effects on clinical outcomes are less certain, given the predominance of before‐and‐after designs and inconsistent findings for hospital length of stay. The review identifies implementation strategies that can guide future sepsis quality improvement initiatives.
Implications for the Profession and/or Patient Care
Nurse‐driven protocols may support nurses in initiating timely sepsis care and strengthening adherence to recommended care processes. Further high‐quality studies are needed to establish effects on clinical outcomes and broader impacts, including healthcare costs, intensive care resource utilization, patient and nurse satisfaction, and safety outcomes.
Patient or Public Contribution
No patient or public contribution.