Marjon Borgert

159 Implementation of the transfusion bundle residents half-yearly. Depending on the estimated workload and the severity of illness, the nurses are assigned to one or two patients. The ICU is divided into two nursing teams, working on two units each. Nurses are working in either one of the two teams. Study subjects The study included ICU nurses of two nursing teams who transfused at least one unit of RBCs from May to December 2014. Per nursing team a di erent A&F strategy was used to introduce the transfusion bundle. One team was randomly assigned to the intervention group and the other to the control group. Nurses’individual performances, i.e. transfusion bundle compliance, wasmeasured. Nurses’compliance to the bundlewas measured by the researcher after every transfusion. In both teams, nurses were excluded from the analysis with long-term illness, pregnancy leaves, and newly employed during the study period. Transfusion in patients for whom hemapheresis was indicated or for whom the massive blood transfusion protocol was activated were excluded due the urgency of the situation. The massive blood transfusion protocol was activated in case of the presentation of the following signs or symptoms: (i) decrease in blood pressure; (ii) not responding to uid therapy; and (iii) existence of a high suspicion for bleeding. Furthermore, blood products other than RBCs were excluded. Introduction of the transfusion bundle The ICU consists of two nursing teams containing 63 and 62 nurses. Both teams work separately of each other and have their own nursing management. In both teams, we rst provided education about the transfusion bundle in order to explain the rationale behind each element. During the implementation period, A&F was provided. Both teams received monthly A&F. On top of this, timely individual A&F was provided in only one of the two teams. Education Since we introduced a new transfusion bundle in our ICU, we provided education to both teams in order to explain the concept of care bundles in general, the risks of transfusion and the reasons for using the transfusion bundle. Education was provided in April and May 2014. The way the information was provided and the content of the information was equally in both teams. Nurses rst received information by email containing the following items: (i) explanation of the concept of care bundles; (ii) aim of the transfusion bundle; (iii) explanation of the background/evidence per element. By explaining the risks of transfusion in combination with the aims of the transfusion bundle and the importance of the bundle interventions, we expected this would help to stimulate bundle compliance. Subsequently, nurses were asked to ll out a web based