Marjon Borgert

143 Implementation of care bundles in ICUs Marra 60 2009 and Caserta 61 2012, Brazil Ventilator bundle ITS Phase 1: Mar’01- Dec’02 (imple- mentation HOB + vent circuits) Phase 2: Jan’03-Dec’06 (imple- mentation HOB, vent circuits, heat and moisture exchange). Phase 3 implementation ventila- tor bundle: Jan’07-Sept ‘08 Oct ’08-Dec ‘10 Medical and surgical ICU, 38 beds Compliance In-hospital mortality VAP incidence Nurses, doctors and res- piratory therapists NS AON/ Per month 1) feedback on compliance; 2) posters on compliance rates and VAP rates; 3) per- formance monitoring each weekday and 4) intervene in this process at the same time that performance monitoring was occurring at the bedside if non-compli- ance was detected, 5) brief presentation of VAP to the sta , 6) encourage partici- pation in the“ventilator bundle- getting to zero”program. Phase 3: Apr ‘07: 57% - Sept 100% Oct ‘08: 95%, End: Dec ’10: 99%. Zaydfudim 62 2009, USA, Ventilator bundle ITS Jan ’05-Jul ’08 Tertiary University hospital. Surgical ICU, 21 beds VAP rates Compliance ICU team NS AON/ Per month 1) electronic dashboard: displays compliance with the ventilator bundle parameters for each ventilated patient at timed intervals for each measure; 2) compliance with patient-level dashboard parameters were reviewed twice daily; 3) physician and nursing leadership received daily compliance reports. Aug ‘07: 39% - Jul ‘08: 89% (p<0.001) Crunden 63 2005, UK, Ventilator bundle Retrospec- tive study Group A: Jan ’02 to14 Dec ‘’02. Group B: 15 Dec’02 to 31 Dec ‘03 Single center, 6 ICU beds Compliance Length of MV ICU LOS ICU teams NS Composite/ Per month 1) checklists; 2) daily rounds: every day on the round the sta assess the appropriateness of implementing each element of the bundle per patient; 3) education Audit 1 month. Baseline Oct ‘02: n=21 bundle compliance: 21%, July ‘03: n=24 bundle compliance 79,1% Helmick 39 2014, USA, Ventilator bundle Retrospec- tive review 2009-2011 Multicentre: 5 mixed, 4 medi- cal, 4 surgical and 2 cardiac ICUs. Mean rates of VAP Not reported NS Lowest level of com- pliance/ Per month 1) Checklists 2009: 86.2% 2010: 81.1% 2011: 89.8% P 0.76 Guiliano 64 2011, USA Sepsis resuscitation/ management bundle Pre/post design, pilot Mar 1, ‘06 – Aug 5, ‘08. The 2 pha- ses of the study were completed between this time periods. Phase 1= before intervention, phase 2 after intervention 2 hospitals -compliance -time to com- pletion -time to admini- stration ICU nurses NS Mean percentage of the completion of the bundle/ Time period not clear. 1) education; 2) protocol watch: this is a proprietary CDSS application for bedside monitoring of patients that was designed by Philips Healthcare to assist clinicians in implementing the SSC guidelines. Resuscitation bundle (%, mean (SD)): Phase 1: 57.6 (19.8), phase 2: 68.2 (20), p0.003 Manage- ment bundle: (%, mean (SD)): Phase 1: 84.5 (19) Phase 2: 86.8 (17), p 0.48