Page 70 - ACCCN's Critical Care Nursing

Quality and Safety 47

stop increased (29 to 63%). PUD prophylaxis 100% at both
Compliance with care bundle: DVT prophylaxis decreased
Mean ventilator days reduced from 10.8 days to 6.1 days
(81 to 71%), HOB >30 ° increased (71 to 83%) & sedation
Mean ICU LOS reduced from 13.75 days to 8.36 days

ventilated pts increased 39.5% Unit pt throughput increased 30% and no. of invasively Performance varied widely among & within 13 ICUs Median (ranges): effective assessment of pain 84% (30–98%); appropriate sedation 64% (2–100%); head of bed elevation 67% (42–99%); appropriate SUP 89% (71–98%); appropriate DVT prophylaxis 87% (48–98%) Sig improvement in glucose control (mean of all glucose measurement reduced from 9.9 ± 4.4 to

Findings ● points in time ● (P <0.05) ● ● ● ● ● ●

Evaluated impact of a ventilator care bundle (PUD & DVT prophylaxis, sedation stop, HOB > 30 ° ) on outcomes Audit data by chart review; compliance (pre- and post-implementation of care Measure outcomes over 2 yr study period Only limited improvement in compliance, other factors could have influenced changes Compliance of process measures ‘Appropriateness’ of SUP and DVT prophylaxis not clearly defined or explicitly evaluated Reported resu

Method / Critique ● ● bundle, 7 months apart) ● ● Methods not detailed ● in outcomes ● ● No outcome measures ● ● ● ● ● No randomisation ● analysis not described ● Abbreviations: ICU = intensive care unit; HDU = high dependency unit; QI = quality improvement; CQI = continuous quality improvement; no. = number; b/w = between; yr = year; pts = patients; grp = group; hosp = hospital; sig = significant; mx = management; mech

Baseline audit n = 21 (pt obs.); Post- implementation audit n = 24 Pt outcomes & unit activity: Pre-test: 286; Post-test: 372 512–602 per yr)

n/cohort Not stated 2,764 (range: over 5 yrs
Sample

Setting 6-bed general ICU/ HDU 13 adult medical & surgical ICUs in urban teaching & community hospitals. 12-bed tertiary shock/trauma/ respiratory ICU

Design Retrospective Prospective, cross- sectional, observational Before/after quasi- experimental with historical controls stay; SPC = statistical process control

Study Crunden et al. 2005. (UK) 40 Pronovost et al. 2003. (USA) 52 Clemmer et al. 1999. (USA) 46