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Objective:To construct the evidence-based care bundles for enteral nutrition-related diarrhea in ICU patients and evaluate its effectiveness.Methods:Evidence-based care bundles for enteral nutrition-related diarrhea in ICU patients were constructed according to the best evidence from 5 guidelines. 12 best evidences were summarized, and 12 cluster schemes for diarrhea management were constructed. 175 patients admitted to ICU of Shandong Provincial Hospital Affiliated to Shandong First Medical University from June to December 2020 were selected as the pre implementation group which was given enteral nutrition nursing according to routine nursing measures, and 186 patients admitted to ICU from March to October 2021 were selected as the post implementation group which received nrusing care with evidence-based cluster schemes. The rate of diarrhea in ICU patients undergoing enteral nutrition support before and after using best evidence was compared, and awareness of best evidence among nurses before and after training, and implementation of various measures by nurses after the plan were also compared.Results:After the care bundles were applied, the incidence of diarrhea decreased from 26.29% (46/175) to 11.83% (22/186) with statistically significant difference ( χ2=12.33, P<0.05). The diarrhea knowledge score was improved from 52-100 (75.79 ± 10.18) points to 72-100 (90.00 ± 6.71) points and had a significant difference ( t=-8.88, P<0.05). After the care bundles were applied, the rate of ICU nurses′ diarrhea identification and evaluation, analysis of influencing factors of enteral nutrition associated diarrhea, nasal feeding, selection of enteral nutrition formula and drug were 94.83% (55/58), 91.38% (53/58), 100.00 (58/58), 93.10% (54/58), 94.83% (55/58),significantly improved than 68.97% (40/58), 63.79% (37/58), 81.03% (47/58), 62.07% (36/58), 70.69% (41/58) before applied ( χ2 values were 8.66-14.33, all P<0.01). The implementation rate after the plan was more than 95.00%. Conclusions:The application of the evidence-based care bundles can effectively reduce the incidence of enteral nutrition diarrhea in ICU patients, improve nursing practice and the quality of care.
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The Surviving Sepsis Campaign Bundle: 2018 Update was published recently, in which the time of bundle care is reduced from 3 hours to 1 hour. This update not only reflects the advances in medical studies and practice, but also presents some requirements for normalized treatment of sepsis and management of and cooperation among medical institutions. The guidelines advanced in the "2018 Update", though still lacking high-quality clinical evidence for verification, have made us aware of the importance of early diagnosis and timely intervention of sepsis.
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Objectives: To study the impact of a quality improvement (QI)initiative using care bundle approach on Central-line associatedbloodstream infections (CLABSI) rates.Methods: A QI team for infection control in NICU was formed in atertiary-care neonatal intensive care unit (NICU) from June 2015to August 2016. Baseline data were collected over first 3 monthsfollowed by the intervention period of 1 year. Measures withrespect to strengthening hand hygiene and central line bundlecare were implemented during the intervention period. Auditsassessing the compliance to hand hygiene and CLABSI bundleprotocols were used as process indicators. Multiple PDSA cycleswere used to strengthen the practices of proposed interventions,documentation of data and audits of the processes during thestudy period.Results: The QI initiative achieved a 89% reduction in CLABSIfrom the baseline rate of 31.7 to 3.5 per 1000 line-days. The bloodstream Infections reduced from 7.3 to 2.3 per 1000 patient-days.The overall mortality showed a reduction from 2.9% to 1.7 %during the intervention period. There was a significantimprovement in compliance with hand hygiene protocol andcompliance with CLABSI protocols.Conclusion: This study demonstrated that simple measuresinvolving hand hygiene and strengthening of the care bundleapproach through quality improvement could significantly reducethe blood stream Infections and CLABSI rates
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Objective To discuss the quality improvement effect of the video monitoring management model based on digital ICU for the centralized monitoring of the ICU key index. Methods Selected the ICU key monitoring indicators developed cluster monitoring bundle, using digital ICU monitoring system and clinical management combining synchronous quality supervision and management, developed targeted measures to improve and supervise the implementation, in order to improve the medical quality. Based on the digital ICU in our hospital ICU implementation of key indicators of cluster monitoring and management information for first months the baseline data were compared before and after each index improvement and effect. Results Compared with the pre- implementation period and the baseline survey period, the monitoring times continued to increase by 6 times compared with the baseline. The overall correct implementation rate of the centralized monitoring bundle was increased from 88％(20859/23562) to 98％(107436/109629)from the baseline survey period to July , and the overall correct implementation rate was maintained at about 98 ％ from July to October. Conclusion The management model based on the cluster monitoring of the key indexes of digital ICU can help to improve and improve the medical quality of ICU effectively and continuously, which is beneficial to the management of medical quality in ICU.
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Objective To investigate the efficacy of bundle care under the supervision of professionals in preven-ting ventilator-associated pneumonia(VAP). Methods Patients who received mechanical ventilation between July 2013 and June 2014 in the intensive care unit(ICU)of a hospital were selected,July-December 2013 was as control group (n= 150),patients received bundle care,but without special supervision;January-June 2014 was as special supervision group (n= 177),patients received bundle care under the supervision of professionals,incidence of VAP,duration of mechanical ventilation,and length of ICU stay were compared between two groups. Results In special supervision group,141 patients received invasive mechanical ventilation,mechanical ventilation day were 1937 days,9 patients developed VAP,incidence of VAP was 4.65‰ ;in control group,127 patients received inva-sive mechanical ventilation,mechanical ventilation day were 1965 days,21 patients developed VAP,incidence of VAP was 10.69‰ ,difference was statistically significant between two groups(χ2= 5.68,P= 0.042). In special su-pervision group,overall compliance rate of bundle management strategies,duration of average invasive mechanical ventilation,and length of ICU stay were 94.92% ,(11.11±2.57)days,and(15.11±2.88)days respectively,in con-trol group were 48.67% ,(14.67±4.35)days,and(19.33±5.81)days respectively,difference was statistically sig-nificant between two groups (all P<0.05). Conclusion Bundle care strategies supervised by professionals can ef-fectively prevent the occurrence of VAP,the implementation of bundle care strategies should be set up according to the clinical practice.