Marjon Borgert

142 Chapter 6 Esmail 57 2008, Canada, Ventilator bundle Quality improve- ment: pros cohort Start quality improvement project in 2002- jun’07 ICUs, 38 beds Compliance VAP incidence Critical care team PDSA-cycle AON/ Per month 1) educational sessions; 2) feedback of performance and VAP rates; 3) creation of a multidisciplinary team to work on VAP prevention; 4) family participation: checking bundle compliance; 5) checklists; 6) signs for HOB; 7) HOB alarm on all new beds; 8) newsletters; 9) review a VAP case at meetings;10) posters; 11) audits Modi ed bundle: Sept ‘04: 45% Jun ’07: 100%. Young-quist 10 2007, USA, Ventilator bundle Quality impro- vement: prosp cohort Jan ’03-May ’04 2 hospitals. Medical, surgical and cardiovascular surgery ICU, 40 beds Compliance VAP rates ICU sta NS AON/ Per month 1) fact sheets; 2) posters with VAP rates; 3) written communi- cation to remind and motivate ICU sta ; 4) education of nur- ses in July ‘03; 5) HOB added to preprint ventilator orders: Aug’03; 6) reminder signs for HOB signs at bedside: Sept ‘03; 7) daily multidisciplinary rounds with emphasis on bundle: Jun ‘04; 8) monthly feedback of compliance audits Mercy hospital: May ’03: 0%, Jun ’04: 100%. Unity hospi- tal: May ’03: 0%, Jun ’04: 89%. Mean compliance: 94.5% Bonello 35 2008, USA Ventilator bundle Quality improve- ment: pros cohort Jan ’05-Jun ’06 Multicenter, 8 hospitals, 12 ICUs, 95 beds Compliance VAP rates ICU care providers PDSA-cycle AON/ Per quarter 1) educational symposia; 2) interdisciplinary team rounds; 3) checklist at patient bedside; 4) multidisciplinary imple- mentation teams VAP bundle: First 3 mont- hs: 50%, nal 3 months: 82% Miller 58 2010, USA, Ventilator bundle Quality impro- vement: prosp cohort 1 Jan ’06-30 Apr ’08. VAP bundle implementation began in 2007 University hospital, Trauma ICU, 14 beds Infections rates Nursing sta NS AON/ Per month 1) feedback compliance and VAP rates; 2) online checklist for compliance; 3) real time dashboard view of compliance. For each element of the bundle an indicator is displayed showing status with regard to the desired intervention; 4) education; 5) auditors to monitor and ensure compliance; 6) modi cations to clinical processes; 7) nursing leadership periodically audited compliance Compliance with VAP bundle: Aug ‘07: 12%, Apr ’08: 70% Bukhari 59 2012, Saudi Arabia, Ventilator bundle Prospec- tive longi- tudinal Jan’10-Dec’10 Medical and surgical ICU, 18 beds Compliance Rate of pneumonia Days on MV Lengths of ICU stay Nurses and resi- dents NS AON/ Per month 1) weekly seminars to sta ; 2) checklists; 3) visitors and family education was given and if the bed is not in required position they should inform the treating nurse; 4) daily multi-disciplinary rounds to assess compliance and discuss bundle elements; 5) two surveys entitled: knowledge, attitude and practice of ICU sta on VAP bundles were conducted; 6) respiratory therapists worked collaboratively with nurses; compliance monitoring 8) auditing VAP and compliance; 9) VAP rates presented Whole peri- od: 78,9% Jan ‘10: 30%, Dec’10: 100%.