Using a Bundle Approach to Improve Ventilator Care Processes and Reduce Ventilator-Associated Pneumonia
Using a Bundle Approach to Improve Ventilator Care Processes and Reduce Ventilator-Associated Pneumonia
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DOI：
10.1016/s1553-7250(05)31031-2
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发表时间：
2005-05-01
影响因子：
2.3
通讯作者：
Nolan, Thomas
中科院分区：
文献类型：
--
作者：
Resar, Roger;Pronovost, Peter;Nolan, Thomas
背景资料：呼吸机护理过程的"捆绑"（消化性溃疡疾病预防、深静脉血栓预防、床头抬高和镇静休假）也可能降低呼吸机相关性肺炎（VAP）发生率，可以作为重症监护室（ICU）改善策略的重点。在2002年7月和2004年1月之间，来自61个卫生保健组织的重症监护临床医生团队参加了一个关于改善ICU护理的协作。方法：ICU团队成员每月在基于Web的exhibition上发布数据，并提交叙述性描述，描述测试的变化和实施的策略。对于持续收集呼吸机束元件粘附和VAP发生率数据的35个单位，观察到VAP平均减少44.5%。捆绑包的目标导向性质似乎要求开发提高可靠性所必需的团队合作。观察结果似乎足够稳健，可以支持实施呼吸机捆绑包，为ICU的额外变更提供关注点。
Background: A "bundle" of ventilator care processes (peptic ulcer disease prophylaxis, deep vein thrombosis prophylaxis, elevation of the head of the bed, and a sedation vacation), which may also reduce ventilator-associated pneumonia (VAP) rates, can serve as a focus for improvement strategies in intensive care units (ICUs). Between July 2002 and January 2004, teams of critical care clinicians from 61 health care organizations participated in a collaborative on improving care in the ICU.Methods: ICU team members posted data monthly on a Web-based extranet and submitted narrative descriptions describing the changes tested and the strategies implemented.Results: For the 35 units that consistently collected data on ventilator bundle element adherence and VAP rates, an average 44.5% reduction of VAP was observed.Discussion: The goal-oriented nature of the bundle appears to demand development of the teamwork necessary to improve reliability. The observations seem sufficiently robust to support implementing the ventilator bundles to provide a focus for additional change in ICUs.