Marjon Borgert

137 Implementation of care bundles in ICUs Longmate 31 2011, UK, Central line bundle Quality impro- vement: pre/post design Baseline: 1 Sep’05- 31 Aug’06. Intervention: Mrt’08-Aug’09 Medical and surgical ICU, (9 beds) CLABSI rates. Care processes: reliability. Nurses and doctors Scottish Pa- tient Safety program. AON/ Per month 1) Active engagement of sta , 2) educational programs, 3) measurement and feedback of outcomes, 4) insertion checklist, 5) organizational change, 6) introduction of the Scottish Patient Safety program, 7) measurement of insertion processes and feedback, 8) ownership of nurses of the two bundles Insertion bundle compliance per month: Mar ‘08: 80% to Aug ‘09: 95% Khalid 32 2013, Saudi Arabia, Central line bundle Quality improve- ment: pre/post design Pre intervention: Febr ’09-Jan ‘10 Postintervention yr1: Aug’10- Jul’11 Yr 2: Aug’11- Jul’12 Tertiary care hospital, med- ical/surgical ICU: 18 beds CLABSI rates Physicians and 101 nurses. Nurse-pt ratio: 1:1, 1:2 NS Not clear/ Per month 1) education sessions; 2) audits, 3) checklists; 4) daily reminders; 5) yers Insertion bundle: Pre- int: 85% Postint yr 1: 96%, yr 2: 99%. Maintenance bundle: Pre intervention: 75%. Post int yr. 1: 91%, yr 2: 97%. Render 33 2011, USA, Central line bundle Obser- vational cohort study Apr’06-Apr’09 Multicenter, General, me- dical, surgical and cardiac ICUs: 174 ICUs (1774 beds) 1. Adherence bundle elements 2. CLABSI rates Nurses PDSA cycles Composite/ Per quarter 1) hospital leadership, 2) learning module, 3) physician champion, 4) use of central line cart, 5) checklist during line insertion as a forcing function, 6) addition of a daily goal sheet during physician rounds as a memory aid for CL remo- val. 7) feedback about CLABSI rate and bundle adherence 8) web based toolbox with education materials (for sharing in multicenter setting). 9) ICU dashboard progress in CLABSI rates in own ICU compared with national rates. Apr to Dec ‘06: 85%, 2009: 98% Richardson 34 2012, USA, Central line bundle Evidence Based Practice project/ quality improve- ment: Prosp cohort May ‘06- May ‘10 Medical and surgical ICU (Number of beds NS) Infection rates Nurses and phys- icians NS AON/ Per quarter 1) Implementation team of clinical nurse specialists, 2) education every 6 months (didactic lectures simulation laboratory, emails, quiz format etc), 3) checklist en modi ed this when needed, 4) nurses empowered to stop the procedure if any of the required bundle item practices were not being followed, 5) nursing and medical leadership, 6) ‘Hot team’facilitated the group in determining the logistics for the work that needed to be done, they met monthly, established a web page on intranet and posted literature, relevant policy, procedure statements, education les as pp presentations, auditing forms, 7) feedback on compliance and infection rates. Compliance during the whole study period: >90%. Bonello 35 2008, USA, Central line bundle Quality improve- ment: Prosp cohort Jan’05 - Jun’06 Multicentre, 12 ICUs, (95 beds) Process measures: adherence to CL insertion checklist. CRBSI rates. ICU care providers Quality Im- provement Collaborati- ve using the PDSA cycle AON/ Per quarter 1) Educational symposia, 2) interdisciplinary team rounds, 3) checklist at bedside. 4) multidisciplinary implementation teams CL bundle: First 3 mont- hs: 58%, Final 3 months: 74%