Marjon Borgert

139 Implementation of care bundles in ICUs Hawe 41 2009, UK, Ventilator bundle Pre/post design Passive implementation period: Sep ’05- feb ’07. Active period: 1 Mar ’07-31 Dec ‘07 Medical & Surgical ICU Compliance VAP incidence Unit mortality Medical and nursing sta NS AON/ Per month Passive period: 1) formally adopted as unit policy; 2) lamina- ted copies of the bundle at pt bedside; 3) verbal and written encouragement for its use at ward rounds and other times. Active period: 1) educational intervention: multidisciplinary education meetings; 2) workshops for medical and nursing sta presenting the de nition, pathogenesis, epidemiology and risk factors of VAP; 3) Written material for self-study was distributed; 4) assessment of bundle compliance during daily rounds; 5) Feedback of process measurement; 6) feedback of outcomes measurement and organizational change; 7) Barriers a ecting delivery of care were identi ed and iteratively improved. Passive peri- od: Nov ‘06: 0% Active period: may ‘07 48%, Oct ‘07: 54% (chi square p value: <0.0001) Bloos 42 2009, Germany, Ventilator bundle Pre/post design Total period: Jun ’05-Jun ’06. Pre intervention: Jun-Sep ‘05, Post intervention Mar-Jun’06 General ICU, 50 beds. Compliance ICU LOS Rates of pneu- monia Days on MV ICU survival ICU nur- ses and residents NS AON/ Overall: 4 months 1) educational meetings: scienti c background and techniques of the bundle were taught to all nurses and residents in daily seminars for 2 months; 2) red marks on the wall to indicate a correct semi recumbent position; 3) individually training of nurses or residents if the bundle was not correctly applied (for 2 months); 4) change team (for training sta ): consisting of ICU manager, ICU consultant, ICU residents and nurses. Audit 1: 15%, Audit II: 33,8% (p<0,01) Al-Taw q 43 2010, Saudi Arabia, Ventilator bundle Pre/post design Pre intervention: Jan-Dec ’06. Post implementation: Jan ’07-Dec ‘08 Private gen- eral hospital, Medical, Sur- gical, Cardiac ICU 18 beds Compliance Device utilization ratio VAP rate Nurses, doctors and res- piratory therapists NS AON/ Per quarter 1) education of sta ; 2) feedback of compliance to team + quarterly feedback of compliance and VAP rates; 3) checklist; 4) audit tool; 5) daily multidisciplinary rounds; 6) team approach to drive and maintain the initiative (including infection control professional, nurse, respiratory therapist, intensivist and chairman of the infection control committee). 7) if non-compliance with an element was detected, the nurse intervened in this process at the time of monitoring process. First 3 month of implemen- tation period ( rst quarter 2006): 20%, Last 3 month (fourth quarter 2008) of implemen- tation period 82%. Jimenez 44 2009, USA, Ventilator bundle Pre/post design Pre intervention 2 weeks. 4 months of non-measu- rements. Post intervention 2 weeks. Neuro surgical ICU, 18 beds Compliance Nursing sta NS AON + Item-by- item/ Per 2 weeks 1) education sessions; 2) weekly feedback on compliance; 3) posters; 4) reminder cards; Pre educati- on: n= 102, compliance 6 %, Post edu- cation, n= 86, compliance 59%