Marjon Borgert

141 Implementation of care bundles in ICUs Malouf Todaro 51 2013, USA, Ventilator bundle Quality impro- vement: pre/post design Pre intervention 2 months. Post interventi- on 6 months Medical and surgical ICU, 24 beds. Compliance Nurses NS AON/ Overall: 6 months 1) education; 2) use of electronic checklists and developed in collaboration with focus groups of ICU nurses and physicians. Pre interven- tion: 5/137 (3,7%) Post intervention: 464/504 (92.1%) Rello 52 2013, Spain, Ventilator bundle Prospecti- ve cohort Baseline: 3 months. Inter- vention period: 16 months Multicenter, 5 general ICUs Compliance VAP rates ICU length of stay Duration of MV ICU teams NS Lowest level of com- pliance/ Overall: 6 months 1) feedback on VAP rates and compliance in the form of posters and feedback to improvement team; 2) local ICU improvement teams (incl medical leader and nurse mana- ger); 3) posters; 4) cards and brochures to educate sta ; 5) education; 6) checklist Compliance rate comple- te bundle: 20% Berenholtz 53 2004, USA, Ventilator bundle Prospec- tive cohort 4 Mar ’02-29 Apr ’02 (8 weeks) Tertiary hos- pital. Surgical ICU, 20 beds (14 in use). Percentage of ventilator days per week Compliance Nursing sta NS Composite / Per week 1) survey to identify barriers of compliance, 2) education to provide a summary of the evidence; 3) checklist to be completed daily during daily rounds; 4) billboard within ICU to highlights the project and post the performance; 5) interdisciplinary team to lead Quality Improvement e ort; 6) discuss performance during daily rounds; 7) adding topics to the agenda at monthly performance improvement meetings Before start intervention: 30%, after interven- tion: 96% (p<0.001) DePalo 54 2010, USA Ventilator bundle Prospecti- ve cohort Data reported from 1 Jan ‘06 - 30 Jun ‘08. Baseline period: 1 Jan ‘06- Mar ‘06. Multi center, 11 hos- pitals, 23 ICUs, 263 beds VAP rates Not reported Patient safe- ty program AON/ Per quarter 1) patient safety based program: educate sta on science of safety, learning from defects and implementing work tools and empowered to stop procedures. 2) Education, 3) feed- back of infection rates 4) survey culture: culture assessment tool used to survey the culture of each ICU, administered at the start of the project and annually thereafter. 5) engage- ment, 6) empowering nurses to stop physicians who do not follow the checklist 7) implementation teams, 8) checklists Quarter 1 ‘06: 60%, Quarter 2 ‘08: 78% (p<0.0001) Al-Thaqafy 55 2014, Saudi Arabia, Ventilator bundle Prospec- tive cohort Jun’10-Dec’13 Tertiary hos- pital, medical, surgical and trauma ICU, 21 beds. Compliance VAP rates Association between compli- ance and ventilator utilization Nurses and phy- sicians. Nurse to patient ratio is 1:1 NS AON/ Per quarter 1) Periodic educational and training sessions; 2) daily multi- disciplinary rounds; 3) no blame policy Compliance Q2 2010: 86% to 99% in Q4 2013 Hatler 56 , 2006, USA, Ventilator bundle Quality impro- vement: prosp cohort 15 months Medical ICU, 8 beds Compliance VAP rates Nursing sta Theory of planned behaviour AON/ Per month 1) education; 2) one-page document detailing new strategies to address prevention of VAP; 3) regular feedback infection rates and rates of adoption; 4) multidisciplinary project team to monitor progress and to make needed changes during implementation; 5) daily rounds; 6) daily goals were posted on white boards in patient rooms; 7) charts of expected activities were posted in each patient room; 8) reinforcement by giving movie tickets to nurses; 9) when sign. change was accomplished, sta members, managers and administrators celebrated with prizes; 10) newsletters Begin: 73%, end of the intervention period: 98.6% (p<0.001)