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Objective:To explore the effect of bundle management strategy in early mobility of patients with mechanical ventilation.Methods:Seventy-two mechanically ventilated patients admitted to the respiratory intensive care unit (RICU) of Fenyang Hospital of Shanxi Province from December 2019 to June 2020 were enrolled. The patients were divided into routine nursing control group (routine control group) and early mobility bundle management group (bundle group), with 36 cases in each group. The routine control group received regular nursing, including monitoring vital signs, raising the head of the bed, turning over and buttoning the back every 2 hours, daily awakening, airway humidification, prevention of digestive tract ulcer, analgesia and sedation management, prevention of deep vein embolism, pipeline management, regular monitoring of blood gas analysis and electrolytes according to the changes of the condition, prevention of aspiration, prevention of bacterial colonization, correct hand hygiene, and so on. The bundle group implemented the cluster early mobility strategy based on routine nursing. Firstly, set up a professional team to execute the standards. The team determined the plan and implemented the 4-level mobility plan, companied with psychological intervention, decided the termination standard and quality control. The incidence of intensive care unit acquired weakness (ICU-AW), ventilator-associated pneumonia (VAP), delirium, the duration of mechanical ventilation and the length of intensive care unit (ICU) stay were evaluated.Results:Compared with the routine control group, the incidences of ICU-AW, VAP, and delirium in the bundle group were significantly lower (the incidence of ICU-AW: 36.11% vs. 69.44%, χ 2 = 8.025, P = 0.005; the incidence of VAP: 8.33% vs. 30.56%, χ 2 = 5.675, P = 0.017; the incidence of delirium: 5.56% vs. 36.11%, χ 2 = 10.180, P = 0.001), the duration of mechanical ventilation was significantly shorter (days: 7.13±1.34 vs. 10.46±1.48, t = -10.145, P < 0.001), and the length of ICU stay was also significantly decreased (days: 9.03±2.43 vs. 13.06±3.63, t = -5.535, P < 0.001). Conclusions:The implementation of bundle management strategy of early mobility can promote the rehabilitation of mechanical ventilated patients, improve the prognosis and the quality of life. The effect is noticeable and it is worth popularizing.
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Objective The explore the effect of blood pressure bundle management on prognosis of patients with acute ischemic stroke after intravenous thrombolysis. Methods A total of 286 acute ischemic stroke patients, who received intravenous thrombolytic therapy in Stroke Center of our hospital between Oct. 1, 2015 and Mar. 31, 2018, were included in this study. The patients who received blood pressure bundle management after intravenous thrombolysis were assigned to bundle group, and the patients without blood pressure bundle management were in control group. The baseline data, National Institutes of Health stroke scale (NIHSS) score on admission, blood pressure before thrombolysis, the incidence of symptomatic intracranial hemorrhage and the in-hospital mortality after thrombolysis, and the 90-d modified Rankin scale (mRS) score were compared between the two groups. Multivariate logistic regression analysis was used to explore the effect of blood pressure bundle management, NIHSS score, onset-to-needle time, and blood pressure on prognosis of patients. Results Of 286 patients with acute ischemic stroke, 161 patients were in bundle group, and 125 patients were in control group. There were no significant differences in age, gender, hypertension, diabetes mellitus, atrial fibrillation, NIHSS score on admission or blood pressure before thrombolysis between the two groups (all P0.05). The incidence of symptomatic intracranial hemorrhage was significantly lower in the bundle group than that in the control group (2.48% [4/161] vs 8.00% [10/125], χ2＝4.598, P＝0.032). There was no significant difference in the in-hospital mortality between the two groups (3.73% [6/161] vs 3.20% [4/125], χ2＝0.058, P＝0.810). The 90-d good prognosis (mRS score 0-2) rate was significantly higher in the bundle group than that in the control group (62.11% [100/161] vs 49.60% [62/125], χ2＝4.485, P＝0.034). Successive variation of systolic blood pressure and successive variation of diastolic blood pressure were significantly lower in the bundle group than those in the control group ([13.37±4.92] mmHg [1 mmHg＝0.133 kPa] vs [18.42±3.87] mmHg, t＝2.437, P＝0.025; [11.23±4.02] mmHg vs [15.48±5.16] mmHg, t＝1.842, P＝0.046). Multivariate logistic regression analysis showed that blood pressure bundle management (odds ratio [OR]＝0.798, P＝0.002) and successive variation of diastolic blood pressure≤15 mmHg (OR＝0.816, P＝0.018) were independent predictors for good prognosis of acute ischemic stroke patients with intravenous thrombolysis. Conclusion Blood pressure bundle management can improve blood pressure variation of the patients with acute ischemic stroke after receiving intravenous thrombolysis, reduce the incidence of symptomatic intracranial hemorrhage and improve the prognosis of the patients.
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Objective To explore the application of bundle strategies in the management of multidrug-resistant or-ganisms(MDROs).Methods From July 1 ,2013,bundle intervention measures were applied in the management of MDROs from inpatients in a tertiary first-class hospital,the implementation of isolation measures for MDRO-infec-ted/colonized patients were monitored,April-June 2013 was pre-intervention group,July-September 2013 was the first stage of intervention,October-December 2013 was the second stage of intervention,the qualified rate of each measure and incidence of MDRO infection per 1 000 patient-days before and after intervention were compared. Results From April to December 2013,a total of 3 430 non-repetitive isolates were detected.The qualified rate of doctors’ order “contact isolation ”before intervention and in the second stage of intervention were 78.14% and 95.95% respective-ly;the qualified rate of hanging bed-side isolation signs,providing bed-side quick-drying hand disinfectant,and patients wearing blue wristbands before intervention were 52.70%,66.89%,and 87.16% respectively,and in the second interven-tion stage were all 100.00%.The qualified rate of disinfection of medical supplies and environment,as well as patients’ bed assignments before intervention were 23.65% and 15.54% respectively,in the second stage were 79.79% and 77.66% respectively.Health care workers’awareness rate of hand hygiene knowledge,hand hygiene compliance rate,and hand hygiene correct rate before intervention were 69.70%,45.76%,and 76.35% respectively;in the second stage were 90.23%,87.50%,and 94.58% respectively;the qualified rate of implementation of each isolation measure before inter-vention and in different stages after intervention were all significantly different(all P <0.01).The incidence of MDRO in-fection per 1 000 patient-days before intervention,in the first and second intervention stages were 3.24‰,2.63‰,and 2.20‰ respectively.Conclusion After the monitoring and intervention in MDROs with bundle management strategies,the qualified rate of each measure improved,incidence of MDRO infection per 1 000 patient-days decreased.