Faculty of nursing

Master degree
)1st semester(

Patient safety
bundles
for critical care

Supervised :Dr :Sahar shafek

Prepared :Group (2)

 PREPARED :GROUP (2)
Khaled hossam
Omnia ramzy
Sara yeiha abdelnabe
Shima mahdi
Yosra taha
Rehab Mohamed
Wessam Ismael
Asma salah .
Ahmed Mohamed Mohamed
Neama kadry
 :Goal
To empower participant to Knowledge, skills
&positive attitude toward patient bundle of
care

:Objectives
At the end of this lecture every participant
will be able to:-
• Bundles, According to the institute for
health car improvement
• institute for health car improvement
ctritical car bundle
• List types of bundle care
• Intervention of bundle
:Outline
Introduction Bundles, According to the
institute for health care improvement
Define of bundle
List types of bundle care
1- Ventilator Bundle
2-Central Line Bundle
3-Severe Sepsis Bundles
Reference:-
Bundles, According to the institute for
health car improvement
• In a bundle, the individual elements are
built around best evidence-based
practices.
• The science supporting the individual
treatment strategies in a bundle is
sufficiently mature such that
implementation of the approach should be
considered either best practice or a
reasonable and generally accepted
practice.

Definition
• A "bundle" is a group of evidence-based
care components for a given disease that,
when executed together, may result in
better outcomes than if implemented
individually.
institute for health care improvement
Critical Care Bundles

• Ventilator Bundle
• Central Line Bundle
• Severe Sepsis Bundles

1-VAP BUNDLE

institute for health car improvement

patient safety bundles
Ventilator-Associated Pneumonia
(VAP)Bundle:
DVT prophylaxis
GI prophylaxis
Head of bed (HOB) elevated to
30-45
Daily Sedation Vacation
Daily Spontaneous Breathing
Trial
DVT prophylaxis: tips

• Include deep venous prophylaxis as part of

your ICU order admission set and
ventilator order set. Make application of
prophylaxis the default value on the form.
• Include deep venous prophylaxis as an item
for discussion on daily multidisciplinary
rounds.
• Empower pharmacy to review orders for
patients in the ICU to ensure that some
form of deep venous prophylaxis is in place
at all times on ICU patients.
• Post compliance with the intervention in a
prominent place in your ICU to encourage
change and motivate staff.

GI prophylaxis: tips

• Include peptic ulcer disease prophylaxis as

part of your ICU order admission set and
ventilator order set. Make application of
prophylaxis the default value on the form.
 • Include peptic ulcer disease prophylaxis as
an item for discussion on daily
multidisciplinary rounds.
• Empower pharmacy to review orders for
patients in the ICU to ensure that some
form of peptic ulcer disease prophylaxis is
in place at all times on ICU patients.
• Post compliance with the intervention in a
prominent place in your ICU to encourage
change and motivate staff.

Head of Bed elevation: tips I

• Implement a mechanism to ensure head-

of-the-bed elevation, such as including this
intervention on nursing flow sheets and as
a topic at multidisciplinary rounds.
• Create an environment where respiratory
therapists work collaboratively with
nursing to maintain head-of-the-bed
elevation.
• Involve families in the process by educating
them about the importance of head-of-
the-bed elevation and encourage them to
notify clinical personnel when the bed
does not appear to be in the proper
position.
 • Use visual cues so it is easy to identify
when the bed is in the proper position,
such as a line on the wall that can only be
seen if the bed is below a 30-degree angle.
• Include this intervention on order sets for
initiation and weaning of mechanical
ventilation, delivery of tube feedings, and
provision of oral care.
• Post compliance with the intervention in a
prominent place in your ICU to encourage
change and motivate staff.
/Daily sedation vacation
Spontaneous Breathing Trials: tips
• Assess that compliance is occurring each
day on multidisciplinary rounds.
• Consider implementation of a sedation
scale such as the Riker scale to avoid
oversedation.
• Post compliance with the intervention in a
prominent place in your ICU to encourage
change and motivate staff.
Central Line BUNDLE
institute for health car
improvement patient safety
bundles
 • Central line bundle:
• Hand Hygiene
• Maximal Barrier Precautions Upon
Insertion
• Chlorhexidine Skin Antisepsis
• Optimal Catheter Site Selection, with
Avoidance of the Femoral Vein for Central
Venous Access in Adult Patients
• Daily Review of Line Necessity with Prompt
Removal of Unnecessary Lines

Hand Hygiene: tips I

• Empower nursing to enforce use of a
central line checklist to be sure all
processes related to central line placement
are executed for each line placement.
• Include hand hygiene as part of your
checklist for central line placement.
• Keep soap/alcohol-based hand washing
dispensers prominently placed and make
universal precautions equipment, such as
gloves, only available near hand sanitation
equipment.
• Post signs at the entry and exits to the
patient room as reminders.
 • Initiate a campaign using posters including
photos of celebrated hospital
doctors/employees recommending hand
washing.
• Create an environment where reminding
each other about hand washing is
encouraged.
• Signs often become "invisible" after just a
few days. Try to alter them weekly or
monthly (color, shape size).

Maximal Barrier Precautions

Upon Insertion: tips
• Empower nursing to enforce use of a
central line checklist to be sure all
processes related to central line placement
are executed for each line placement.
• Include maximal barrier precautions as part
of your checklist for central line placement.
• Keep equipment ready stocked in a cart for
central line placement to avoid the
difficulty of finding necessary equipment
to institute maximal barrier precautions.
Chlorhexidine skin antisepsis: tips
 • Empower nursing to enforce use of a
central line checklist to be sure all
processes related to central line placement
are executed for each line placement.
• Include Chlorhexidine antisepsis as part of
your checklist for central line placement.
• Include Chlorhexidine antisepsis kits in
carts storing central line equipment. Many
central line kits include povidone-iodine
kits and these must be avoided.
• Ensure that solution dries completely
before an attempted line insertion.
Optimal catheter site selection: tips

• Empower nursing to enforce use of a

central line checklist to be sure all
processes related to central line placement
are executed for each line placement.
• Include optimal site selection as part of
your checklist for central line placement
with room for appropriate
contraindications (e.g., bleeding risks).
/Daily review of Lines
Prompt removal: tips
• Empower nursing to enforce use of a
central line checklist to be sure all
 processes related to central line placement
are executed for each line placement.
• Include daily review of line necessity as
part of your multidisciplinary rounds.
• Include assessment for removal of central
lines as part of your daily goal sheets.
• Record time and date of line placement for
record keeping purposes and evaluation by
staff to aid in decision making.
•
Severe Sepsis BUNDLES
institute for health car improvement
severe sepsis bundles

The sepsis resuscitation bundle

The sepsis management bundle

Sepsis resuscitation bundle

• describes seven tasks that should begin
immediately, but must be accomplished
within the first 6 hours of presentation for
patients with severe sepsis or septic
shock.
• Some items may not be completed if the
clinical conditions described in the bundle
 do not prevail in a particular case, but
clinicians should assess for them.
• The goal is to perform all indicated tasks
100 percent of the time within the first 6
hours of identification of severe sepsis.
Sepsis management bundle
• Lists four management goals.
• Efforts to accomplish these tasks should
also begin immediately.
• These items may be completed within 24
hours of presentation for patients with
severe sepsis or septic shock
Sepsis resuscitation bundle: details
• Serum lactate measured
• Blood cultures obtained prior to antibiotic
administration
• Improve time to broad-spectrum antibiotics
• Treat hypotension and/or elevated lactate
with fluids
• Apply vasopressors for ongoing
hypotension
• Maintain adequate central venous pressure
• Maintain adequate central venous oxygen
saturation
Sepsis management bundle: details
• Administer Low-Dose Steroids by a
Standard Policy
• Administer Drotrecogin Alfa (Activated) by
a Standard Policy
• Maintain Adequate Glycemic Control
• Prevent Excessive Inspiratory Plateau
Pressures
•
•