title: An evaluation of the impact of the ventilator care bundle.
abstract: A number of interventions have been shown to improve the outcomes of patients who are invasively ventilated in intensive care units (ICUs). However, significant problems still exist in implementing research findings into clinical practice. The aim of this study was to assess whether the systematic and methodical implementation of evidence-based interventions encapsulated in a care bundle influenced length of ventilation and ICU length of stay (LOS). A ventilator care bundle was introduced within a general ICU and evaluated 1 year later. The care bundle was composed of four protocols that consisted of prophylaxis against peptic ulceration, prophylaxis against deep vein thrombosis, daily cessation of sedation and elevation of the patient's head and chest to at least 30 degrees to the horizontal. Compliance with the bundle was assessed, as was ICU LOS, ICU mortality and ICU/high-dependency unit patient throughput. Mean ICU LOS was reduced from 13-75 [standard deviation (SD) 19.11] days to 8.36 (SD 10.21) days (p<0.05). Mean ventilator days were reduced from 10.8 (SD 15.58) days to 6.1 (SD 8.88) days. Unit patient throughput increased by 30.1% and the number of invasively ventilated patients increased by 39.5%. Care bundles encourage the consistent and systematic application of evidence-based protocols used in particular treatment regimes. Since the introduction of the ventilator care bundle, length of ventilation and ICU LOS have reduced significantly.
authors.affiliation: Critical Care, Intensive Care Unit, East Surrey Hospital, Redhill, Surrey, UK. eddie.crunden@sash.nhs.uk
authors.forename: Eddie
authors.initials: E
authors.lastname: Crunden
authors.forename: Carolyn
authors.initials: C
authors.lastname: Boyce
authors.forename: Helen
authors.initials: H
authors.lastname: Woodman
authors.forename: Barbara
authors.initials: B
authors.lastname: Bray
mesh_terms: D018806:APACHE; D002985:Clinical Protocols / Q000592:standards; D016292:Procedural Sedation / Q000451:nursing / Q000592:standards; D003422:Critical Care / Q000458:organization & administration*; D019091:Critical Pathways / Q000458:organization & administration*; D004739:England / Q000453:epidemiology; D019317:Evidence-Based Medicine / Q000458:organization & administration; D019983:Guideline Adherence / Q000592:standards; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D009731:Nursing Audit; D015403:Nursing Evaluation Research; D017063:Outcome Assessment, Health Care / Q000458:organization & administration; D010437:Peptic Ulcer / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D012121:Respiration, Artificial / Q000009:adverse effects / Q000401:mortality / Q000451:nursing* / Q000592:standards; D012189:Retrospective Studies; D016019:Survival Analysis; D017749:Total Quality Management / Q000458:organization & administration; D020246:Venous Thrombosis / Q000517:prevention & control