Marjon Borgert

115 Implementation of care bundles in ICUs outcomes. Therefore, a narrative synthesis of the data is presented. This systematic review follows the standards of the preferred reporting items for systematic reviews and meta-analysis (PRISMA). 26 Table 1. Explanation of the implementation strategies using the EPOC taxonomy 21-23 Implementation strategy Examples within the implementation of care bundles Professional interventions Distribution of educational materials (Web based) toolbox with educational materials, written material for self-study Educational meetings Educational meetings, seminars, workshops, teaching sessions Local consensus processes Development care bundle or materials or discussing about patients who developed an infection. Educational outreach visits Use of a trained person who met professionals on the ICU to give information with the intent of changing practice. Local opinion leaders Nursing and/or medical leadership Audit and feedback Audits and feedback on infections rates or bundle compliance. Use of dash boards Reminders (Run) charts, checklists with bundle elements, daily goal sheets, insertion, HOB alarms Tailored Focus groups or (survey to) identify barriers Mass media Posters, fact sheets, newsletters, brochures to reach a great number of sta Other; Time out procedure Time out procedure, empower to stop procedure Patient intervention Patient-family interventions Family education of the bundle elements or family participation Organizational interventions Revision of professional roles Shifting of roles among sta Clinical multidisciplinary teams (Daily) multidisciplinary rounds, multidisciplinary teams Skill mix changes Changes in the number of sta Continuity of care Group of doctors to remove catheters daily Satisfaction of providers Nursing and medical champions, material rewards and sta engagement Other; Implementation teams Special team is actively involved to implement the care bundle, improvement teams Structural interventions Changes in medical record system Changes in a medical record system for electronic documentation