Marjon Borgert

120 Chapter 6 Time frame compliance calculation Compliance was calculated over di erent time frames, i.e. some studies calculated compliance for each month, while others measured the overall compliance over a longer period, i.e. 1 or 2 years. In three studies about ventilator bundle implementation compliance rates of 100% were reached. 57,59-61 In these studies the compliance was calculated monthly by using the AON approach. Two studies reported low compliance levels of 30 and 34% respectively. 42,52 In these studies the compliance was measured using the AON approach over the whole study period (Supplementary File 3). In most studies about sepsis bundle implementation, the level of compliance was measured using the AON approach. Only one study used the item-by-item measurement to report compliance. 66 The compliance levels for sepsis bundles were exceptionally low compared to the central line and ventilator bundles (Supplementary File 3). Two studies reported compliance levels of 68% and 70% respectively. 64,68 However, these studies were performed in small patient numbers. E ects on compliance The rst subset of studies that was analysed, included studies with pre/post designs, which were quali ed as either ‘good’ or ‘fair’, and in which compliance was calculated by using the AON approach. Supplementary File 5, Figure S1 shows that, overall, there is no association between the number of strategies used and compliance levels ( r = 0.118, 95% CI. -0.331 to 0.523, p = 0.612). The same applies when the bundles are analysed separately. As shown in Table 2, di erent strategies were used in combination for implementation of care bundles. For the implementation of the central line and ventilator bundle, the combination of education, reminders and A&F was used. For the implementation of the sepsis bundle, education is mainly used in combination with distribution of educational materials. Overall, there is neither an association between compliance and the number of elements (ρ = 0.140, p = 0.545) nor between compliance and the time frame used to calculate compliance (τ = -0.080, p = 0.639). The second subset of studies that was analysed, included prospective cohort studies with quality assessments of either ‘good’ or ‘fair’ and in which compliance was calculated using the AON approach. Supplementary File 5, Figures S4 to S6 show that there is a variety in compliance levels. Moreover, no association can be found between the number of implementation strategies (ρ = 0.539, p =0.057), bundle elements (ρ = -0.303, p = 0.314) and time frame used for measuring compliance (τ =-0.189, p =0.417).