Marjon Borgert

188 Chapter 8 PDMS.Wequanti edthenete ectof thebundlebyusingoneof thebundle interventions, i.e. transfusions given according to the patients’ individual Hb-threshold, as we could objectively measure this intervention. We have not actively observed the e ect of the other bundle interventions. However, during the study period no transfusion-related incidents were reported in our ICU incident-reporting system. A mixed method study design, using both qualitative and quantitative research methods, would have given insight in the e ect of the bundle on all interventions, e.g. on the performance of the nal bedside checks. Furthermore, we have not assessed whether the preset threshold was considered adequate for each individual patient as we have chosen to follow clinical practice. Implementation of the transfusion bundle showed moderate levels of bundle compliance. However, high levels of bundle compliance of more than 95% are associated with improved clinical outcomes. In this study, we focused on the number of inappropriate transfusions without taking the cost e ectiveness into account. Future research Future research should focus on implementing a transfusion bundle for other type of blood products, such as fresh frozen plasma or platelets. The transfusion bundle might be an e ective tool to reduce the overall number of inappropriate transfusions. Furthermore, future research should focus on the cost e ectiveness of implementing the transfusion bundle. CONCLUSIONS Introduction of a transfusion bundle results in a signi cant reduction of the number of inappropriate RBCs transfusions in the medical-surgical ICU. Our results show that introduction of transfusion care bundles helps to improve compliance with transfusion guidelines in daily practice.