Implementing a Ventilator Bundle in a Community Hospital
Implementing a Ventilator Bundle in a Community Hospital
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DOI：
10.1016/s1553-7250(07)33026-2
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发表时间：
2007-04-01
影响因子：
2.3
通讯作者：
Susag, Amy
中科院分区：
文献类型：
--
作者：
Youngquist, Paul;Carroll, Michelle;Susag, Amy
背景：明尼苏达州的仁慈和团结医院实施了呼吸机捆绑的概念，这是医疗保健改进研究所(IHI)合作改善重症监护病房(ICU)护理的一部分。方法：这两家医院作为一家单一医院，总共有450张床位，每家都有20张床位。IHI包包括(1)床头抬高，(2)每日“镇静假期”和准备好的脱机评估，(3)消化性溃疡疾病预防，和(4)深静脉血栓预防。可能补充呼吸机捆绑包的其他干预措施是手卫生运动和口腔护理方案。结果：截至2004年1月，四个捆绑包元素的总体遵从性达到100%。在协作结束时，Mercy的VAP率从每千个呼吸机日6.1下降到2.70，Unity的VAP率从每千个呼吸机日下降到2.66到0。讨论：捆绑的全有或全无的性质可能帮助多学科工作人员将该项目视为系统性变化而不是一次性干预。工作人员需要实施结构变化，如呼吸机管理和镇静的预印订单集，以及文化变化，如加强与呼吸治疗的合作。结论：VAP的减少为社区医院干预技术和捆绑实施的潜力提供了一个有希望的例子。
Background: Mercy & Unity Hospitals of Minnesota implemented the ventilator bundle concept as part of an Institute for Healthcare Improvement (IHI) collaborative on improving care in the intensive care unit (ICU).Methods: The two hospitals, which function as a single hospital, have a total of 450 beds, and each has a 20-bed ICU. The IHI bundle was composed of (1) head-of-bed elevation, (2) a daily "sedation vacation" along with a readiness-to-wean assessment, (3) peptic ulcer disease prophylaxis, and (4) deep vein thrombosis prophylaxis. Additional interventions likely complementary to the ventilator bundle were a hand hygiene campaign and an oral care protocol.Results: Overall compliance with the four bundle elements reached 100% by January 2004. At the end of the collaborative, Mercy's VAP rate decreased from 6.1 to 2.70 per 1,000 ventilator days, and Unity's VAP rate decreased from 2.66 to 0 per 1,000 ventilator days.Discussion: The all-or-none nature of the bundle may have helped multidisciplinary staff members perceive the project as a systemic change versus a one-time intervention. Staff members needed to implement both structural changes, such as preprinted order sets for ventilator management and sedation, and cultural changes, such as increased collaboration with respiratory therapy.Conclusion: The decrease in VAP provides a promising example of the potential of intervention techniques and bundle implementation in a community hospital.