title: Improving reliability of clinical care practices for ventilated patients in the context of a patient safety improvement initiative.
abstract: OBJECTIVE
  To investigate perceived factors relating to the reliable application of four clinical care practices targeting ventilator-associated pneumonias, in the context of a patient safety improvement initiative called the Safer Patients Initiative (SPI).
  
  
  METHODS
  Qualitative case study. Seventeen semi-structured individual interviews with clinical operational leads, programme coordinators and executive managers who were involved in the implementation of the programme's critical care work stream during its pilot phase. The interviews had a focus on perceived aspects pertaining to the reliable implementation of the four clinical practices, promoted by the Institute for Healthcare Improvement as the 'ventilator care bundle'.
  
  
  RESULTS
  Thematic analysis of the verbatim transcripts revealed three overarching themes experienced by the participants during the implementation of the clinical practices included in the SPI ventilator care bundle: the power of measurement, feedback to peers and experts and improvement tools specific to SPI. Consistent measurement of compliance with the four elements of the bundle and outcomes made the staff realize that their engagement in previous improvement work for ventilated patients was inadequate and motivated them to apply the introduced clinical practices more reliably. Feedback to experts and peers of staff compliance with the four clinical practices and outcome improvement was perceived as a very influential aspect of SPI. Small tests of change (Plan-Do-Study-Act cycles), teaching sessions and daily goal sheets were quoted as particularly useful tools throughout the implementation of the four clinical care practices.
  
  
  CONCLUSIONS
  Future initiatives that aim to improve the adherence of clinical staff with clinical practice guidelines in intensive care units could benefit from integrating in their methodology consistent measurement and feedback practices of both process compliance and outcome data.
authors.affiliation: Division of Surgery, Department of Surgery & Cancer, Imperial College London, London, UK. a.pinto@imperial.ac.uk
authors.forename: Anna
authors.initials: A
authors.lastname: Pinto
authors.forename: Susan
authors.initials: S
authors.lastname: Burnett
authors.forename: Jonathan
authors.initials: J
authors.lastname: Benn
authors.forename: Stephen
authors.initials: S
authors.lastname: Brett
authors.forename: Anam
authors.initials: A
authors.lastname: Parand
authors.forename: Sandra
authors.initials: S
authors.lastname: Iskander
authors.forename: Charles
authors.initials: C
authors.lastname: Vincent
mesh_terms: D002985:Clinical Protocols / Q000592:standards*; D003422:Critical Care; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008505:Medical Staff, Hospital / Q000523:psychology; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control; D011785:Quality Assurance, Health Care; D015203:Reproducibility of Results; D012121:Respiration, Artificial / Q000451:nursing / Q000592:standards*; D017751:Safety Management; D006113:United Kingdom