Marjon Borgert

156 Chapter 7 ABSTRACT Objective. To investigate the di erence in e ect on transfusion bundle compliance between two Audit and Feedback (A&F) strategies to implement the transfusion bundle. Design and setting . This implementation study was conducted in an ICU of a university hospital fromMay to December 2014. The ICU consists of two nursing teams containing 63 and 62 nurses. Participants. All ICU nurses participated in this study. Intervention. Monthly A&F on team level versus a combination of monthly A&F on team level plus timely individual feedback. Measurements . The primary outcome was bundle compliance. Compliance was measured after every single transfusion. Results. Monthly A&F on team level with timely individual A&F signi cantly improves bundle compliance during implementation compared to monthly A&F on team level alone. The overall e ect of compliance during the study period was signi cantly higher with an OR of 4.05 (95% con dence interval, CI: 1.62 to 10.08), P < 0.001. This indicates that when using the combined A&F strategy nurses are more likely to be compliant to the bundle than when monthly A&F was used alone. Conclusions. Compared to monthly team A&F alone, providing timely individual A&F plus monthly A&F on team level signi cantly improves the success of implementing a transfusion bundle on the ICU during the implementation period. Providing timely individual A&F plus monthly A&F on team level might also be e ective for the implementation of other bundles in healthcare. Future research could elaborate on longer duration of the intervention, the use of information and computer technology to lower costs of the intervention, and to enhance sustainability.