Marjon Borgert

73 A flowchart for building evidence-based care bundles Table 1. (continued) 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 Pulcini 24 , 2008, UK Quality improvement NR Develop and test a set of process measures NR ‘Day 3 bundle’ Assess and improve the reassessment of inpatient empirical antibiotic prescriptions around day 3. 1) Literature search: selection of key process measures by one reviewer 2) selection of 3 to 5 measures thought to be valid and easy to collect. Khalid 11 , 2013, Saudi Arabia Quality improvement 2009- 2012 CLABSI rates Medical- surgical ICU Central line bundle CLABSI reduction in developing countries 1) identify problems with a RCA 2) a owchart was developed to identify the steps in the process and discover the potential weak links in the process. 3) all aspects of central line insertion and maintenance were analyzed and depicted in a owchart 4) by using the owchart: improvement plans and strategic interventions were developed. Kollef 25 , 2011, USA Narrative report/review NR Prevention of nosocomial pneumonia ICU in general VAP prevention bundle Prevention of VAP 1) Using the SMART approach: - S peci c interventions: a) identify bundle elements likely to be successful b) review evidence in support of proposed bundle elements c) consult with experts d) do not become sold on any single bundle element without evidence that it actually works - M easurable outcomes: a) use clinically relevant criteria to de ne outcome (e.g. VAP) b) demonstrated ability to accurately measure outcome of interest c) be aware of reporting biases, especially when using b/a or time series methods - A chievable program a) develop prevention strategy according to availability of local resources b) Target one problem or outcome at a time c) Start with a smaller problem to re ne the local approach then apply to larger problems