Marjon Borgert

160 Chapter 7 questionnaire containing information and questions about the transfusion procedure including the transfusion bundle. Online participation was registered to ensure nurses had read the information and answered the questions. Two senior ICU researchers, an intensivist and one junior researcher, the head nurse and ve ICU nurses were involved in the development process of this educational program. The content was pilot tested by two physicians and two ICU nurses. Furthermore, two information sessions were held for ICU nurses. A presentation about the transfusion bundle was given during hand over meetings to inform residents and physicians. Audit and feedback intervention In this study, we used A&F as the intervention to implement the transfusion bundle. In both teams monthly A&F was provided. On top of this, individual A&F within 72 hours after transfusion was provided in only one of the two teams. The de nition of A&F was in accordance with the E ective Practice and Organisation of Care (EPOC) taxonomy: ‘A summary of health workers’ performance over a speci ed period of time, given to them in a written, electronic or verbal format. The summary may include recommendations for clinical action’. 23 Team A: monthly provided A&F on team level In team A, monthly A&F was provided. At the end of each month, the team received a standardized feedback report by email. This report contained the compliance levels per team for that given month. Feedback was provided by the researcher from the ICU together with the intensivist. Simultaneously, posters were used to show compliance levels. Posters were updated each month. Posters were used as a method to visualize the feedback on compliance levels and to further stimulate compliance. Team B: monthly provided A&F on team level plus timely individual A&F In Team B, the same A&F strategy was used as in Team A. Additionally, individual A&F was provided to the nurse within 72 hours after each RBC transfusion, i.e. further referred as timely individual feedback. Feedback was provided by the researcher and was given either by face-to-face contact or by email in case personal contact was not possible within 72 hours. A standardized report was used. This contained compliance levels of the complete bundle and compliance per element. The time span of 72 hours was chosen so that nurses would still remember the actions they had performed.