Marjon Borgert

71 A flowchart for building evidence-based care bundles Table 1. Study characteristics Author/ year of publication/ country Design Study period Study outcomes ICU Type of bundle Aim of the bundle Methods used in the care bundle design process Hocking 17 , 2013, New Zealand Before and After study Oct 2007- Apr 2011 Central line associated bacteraemia rate General Central line High risk patient bundle Reduce infections In the high risk population 1) Analysis of the implementation data of the CLABSI insertion bundle and maintenance bundle: the data highlighted a group of patients who were continuing to get a CLABSI despite good compliance in both the insertion and maintenance bundle. 2) Search for literature for adding elements in the high risk bundle. Berenholtz 19 , 2007, USA Description of bundle methodology NR Develop a preliminary set of quality measures for ICU patients with sepsis ICU in general Sepsis care bundle Improve outcomes for patients with sepsis 1) Identify evidence based elements that improves outcomes: establish goals of the initiative and discuss potential quality measures 2) Review of the literature 3) Review the literature synthesis: the panel had to list their own recommendations for domains of sepsis care that should be evaluated as a potential quality measure. All measures were discussed in the panel until complete agreement was achieved. 4) Using the GRADE approach to evaluate the quality of the evidence and to balance the potential bene ts and harms for each potential measure. 5) Writing the design speci cation for each measure or explicit de nitions. Consensus in the panel was achieved through an iterative process. Berenholtz 20 , 2004, USA Quality improve-ment Mar 4-Apr 29, 2002 Percentage of ventilator days per week when patients received the bundle elements Surgical Ventilator bundle Reduce infections 1) Qualitative review of the ICU quality indicators: a) Systematic review: identify interventions that improves patient outcomes in the ICU. b) Potential measures were evaluated based on the impact, feasibility, variability and the strength of the evidence to support each measure and to categorize each measure as outcome, process, access or complication measures 2) Four measures retrieved from the search were selected that were associated with improved outcomes in patients receiving mechanical ventilation. 3) These four core measures were grouped into a bundle: the ventilator bundle