Page 67 - ACCCN's Critical Care Nursing

44 S C O P E O F C R I T I C A L C A R E

TABLE 3.6 Institute for Healthcare improvement care bundles

Bundle name Aim Bundle components
Central line Prevent central-line ● hand hygiene
associated bacteraemia ● maximal barrier precautions upon insertion
● chlorhexidine skin antisepsis
● optimal catheter site selection with avoidance of the femoral vein for central
venous access in adult patients
● daily review of line necessity with prompt removal of unnecessary lines
Ventilator care Prevent ventilator- ● elevating the head of the patient’s bed to 30–45 degrees
associated pneumonia ● daily ‘sedation vacations’ or gradually lightening sedative use each day
● daily assessment of the patient’s readiness to extubate or wean from the ventilator
● delivering both peptic ulcer disease and deep vein thrombosis prophylaxis
Sepsis resuscitation Reduce mortality due to ● serum lactate measured
severe sepsis ● blood cultures obtained prior to antibiotic administration
● improve time to broad-spectrum antibiotics
● treat hypotension and/or elevated lactate with fluids
● apply vasopressors for ongoing hypotension
● maintain adequate central venous pressure
● maintain adequate central venous oxygen saturation
Sepsis management Reduce mortality due to ● administer low-dose steroids by a standard policy
severe sepsis ● administer Drotrecogin Alfa (Activated) by a standard policy
● maintain adequate glycaemic control
● prevent excessive inspiratory plateau pressures

● assisted in improving the understanding patient ‘a consolidated and summarized record of an individual’s
therapy goals 49 health information for consumers to access and for use
● improved compliance with safety standards 50 as a mechanism for improving care coordination between
● detected patient safety errors and omissions in care provider teams’.
58 (p.13)
51
care 52,53
● improved compliance with evidence-based In combination with these initiatives, information and
care 44,50,54,55 communications technologies (ICT) are also expanding
60
● proved useful in preparing for a procedure 56 into clinical practice. Critical care in particular is at
● were not time consuming 52-53 or labour intensive 52 the forefront of these developments, with bedside clinical
● when developed in conjunction with clinicians, information systems, order-entry strategies, decision
produce a valid and reliable tool that is consistently support, handheld technologies and telehealth initiatives
used 52 continuing to evolve and influence practice. This section
● enabled collection of real-time process measures to examines the current and future impact that these tech-
assist in the immediate identification of anomalies. 44 nologies will have on patient care and safety, and on clini-
cian workflows and practices, as clinical information fully
Three studies suggested that checklists also contributed assimilates with evidence-based practice and clinical deci-
to improved outcomes: (1) reduced LOS, ventilator days, sion support systems.
49
unit mortality; (2) reduced catheter-related bloodstream
44
infections; and (3) reduced mean monthly rates of
54
VAP. However, the lack of methodological rigour in Clinical Information Systems
these studies prevents inferring causal links between A clinical information system (CIS) enables improved
checklist use and improved outcomes. 57 data collection, storage, retrieval and reporting of patient-
based information, and can facilitate unit-based out-
comes research and quality improvement activities.
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INFORMATION AND COMMUNICATION Computerisation of monitoring and therapeutic activities
TECHNOLOGIES for critically ill patients began in the 1960s, and has now
Health departments continue to develop systems and evolved to encompass all aspects of patient care such as
cardiorespiratory monitoring, mechanical ventilation,
processes that will result in a complete electronic medical fluid and medication delivery, imaging and results of
record. In Australia, a national e-health strategy has been diagnostic testing. 62,63 Patient-based bedside CIS offers
58
established, with the National E-Health Transition increasingly sophisticated functionality and device inter-
Authority (NEHTA), a company established by the faces, enabling real-time data capture, trending and
64
Australian, State and Territory governments, assigned reporting, and linkage to relational databases. 65,66
62
responsibility for establishing the foundations (including
the development of standards) for e-health across the The introduction of intravenous ‘smart pump’ technology
59
Australian health sector. The ultimate goal is an indi- is one application aimed at reducing adverse drug events
vidual electronic health record system designed to provide and improving patient care by supporting evidence-based