title: Timely individual audit and feedback significantly improves transfusion bundle compliance-a comparative study.
abstract: OBJECTIVE
  To investigate the difference in effect on transfusion bundle compliance between two Audit and Feedback (A&F) strategies to implement the transfusion bundle.
  
  
  METHODS
  This implementation study was conducted in an ICU of a university hospital from May to December 2014. The ICU consists of two nursing teams containing 63 and 62 nurses.
  
  
  METHODS
  All ICU nurses participated in this study.
  
  
  METHODS
  Monthly A&F on team level versus a combination of monthly A&F on team level plus timely individual feedback.
  
  
  METHODS
  The primary outcome was bundle compliance. Compliance was measured after every single transfusion.
  
  
  RESULTS
  Monthly A&F on team level with timely individual A&F significantly improves bundle compliance during implementation compared to monthly A&F on team level alone. The overall effect of compliance during the study period was significantly higher with an OR of 4.05 (95% confidence interval, CI: 1.62 to 10.08), P < 0.001. This indicates that when using the combined A&F strategy nurses are more likely to be compliant to the bundle than when monthly A&F was used alone.
  
  
  CONCLUSIONS
  Compared to monthly team A&F alone, providing timely individual A&F plus monthly A&F on team level significantly improves the success of implementing a transfusion bundle on the ICU during the implementation period. Providing timely individual A&F plus monthly A&F on team level might also be effective for the implementation of other bundles in healthcare. Future research could elaborate on longer duration of the intervention, the use of information and computer technology to lower costs of the intervention, and to enhance sustainability.
authors.affiliation: Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
authors.forename: Marjon
authors.initials: M
authors.lastname: Borgert
authors.affiliation: Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: Binnekade
authors.affiliation: Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
authors.forename: Frederique
authors.initials: F
authors.lastname: Paulus
authors.affiliation: Department of Quality Assurance and Process Innovation, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
authors.forename: Astrid
authors.initials: A
authors.lastname: Goossens
authors.affiliation: Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
authors.forename: Margreeth
authors.initials: M
authors.lastname: Vroom
authors.affiliation: Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
authors.forename: Dave
authors.initials: D
authors.lastname: Dongelmans
mesh_terms: D000328:Adult; D001803:Blood Transfusion / Q000592:standards*; D005246:Feedback; D005260:Female; D019983:Guideline Adherence; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged
keywords: Audit and Feedback; care bundles; implementation; intensive care; transfusion