Marjon Borgert

198 Chapter 9 the protocol and better detection of physiological abnormalities, compared to leaving the frequency of measurement up to nurses themselves. In Chapter 3 we analysed the so called ‘false arrests’ in order to determine the ‘level of urgency’. False arrests were de ned as activations of the cardiac arrest team while patients do not actually su er from it. 10-13 This study was conducted in order to nd a scope for improvement in e ciency within the emergency care, thereby saving time and money. Cardiac arrest team activations for false arrests from September 2009 to 2012 were retrospectively analysed. These calls were classi ed as urgent or less-urgent. The results showed that a large part of the activations of cardiac arrest teams for false arrests were classi ed as less urgent. In these cases activation of a RRT might be more appropriate and e cient. It may be suggested that to minimize the activations of cardiac arrest teams for false arrests, nurses need to early recognize patients who clinically deteriorate. In order to do so, the MEWS screening tool should be used correctly. Part II. Improving patient safety of critically ill patients in the ICU. In part II, we describe the development and implementation of evidence-based care bundles. The concept of care bundles was developed by the Institute for Healthcare Improvement (IHI). 14-16 Care bundles were developed in order to enhance the reliability of care and to improve the quality of care. 14-17 They consist of a small set of three to a maximum of ve evidence-based interventions for clinical processes or patient populations. The strength of bundling a small set of interventions together is that evidence-based care will be uniformly applied to every eligible patient, which may result in better patient outcomes than when the interventions were implemented individually. 15,16 In Chapter 4 we conducted a systematic review to identify what methods were available that could support the development of new care bundles for the ICU besides the approach of the IHI. The IHI described the methods used on how to develop care bundles. 15,16 However, these methods may not always be applicable to all ICUs and in every situation. In the literature, other useful methods to design care bundles were published as well. Electronic databases were searched for eligible studies from January 2001 to August 2014. We identi ed useful methods for designing evidence-based care bundles. The results were used to build a comprehensive owchart to provide an overview of the methods used to design care bundles so that others could choose their own applicable method. It guides through all necessary steps in the process of designing care bundles.