PART 1
Are ‘care bundles’ (example sepsis or other) helpful or a hindrance?
Care bundle can be defined as a set of different types of interventions that results in providing more effective output when being utilized together in comparison to when each of these types of interventions are delivered in an independent manner. This approach helps in providing better outcome to a non-structured procedure. Care bundles can be used so that the Healthcare professionals can provide a guarantee that minimum number of standards of care have been maintained and delivered. Many of the researchers have also considered utilizing care bundles as an audit tool that helps in evaluation of the ways by which interventions are provided. However till date the effectiveness of performing individual interventions has not been able to be assessed successfully. with the proper utilization of the care bundles, Health Care Industries can encourage reviews of evidences as well as altering of different clinical care guidelines so that they can successfully prompt education of the staff in providing the best quality care to patients. Many of the researchers have put forward explanation to understand the quality of care provided by the care bundles. They have put forward many researches through which interventions were tested to show whether they are successful in preventing morbidity and mortality of patients ( Berenholtz and team). It is evident from the method that two important forms of care bundles are there that the Healthcare professionals can focus on. The first one is the interventions themselves and the second one is the processes of care delivery. Many of the researchers also see the care bundle as a valuable tool for audit as well as quality assurance. Therefore, it can be referred to as a popular management as well as clinical tools
One of the most commonly used care bundle is the sepsis care bundle and it is a part of the international Surviving Sepsis Campaign. Bundles have become one of the most important parts of the 100000 Live Program and the 5 Million Life Campaign in 2006 in varieties of clinical situations. Within the domain of Critical Care medicine the set of care bundles are seen to B comprising of sepsis, cardiac as well as respiratory failure but they are not limited to this domain is only. The surviving sepsis campaign was a very good example that can be cited here. This was an international initiative that was mainly intending for effective planning and implementation of care bundle method that help in the increasing of the rates of the number of survival of people suffering from severe sepsis by an amount which is near bout 25% (Berenholtz SM, Dorman T, Ngo K, Pronovost PJ2002). The already mentioned care bundles have been found to be extremely successful and therefore they have increased the interest of their use by different professionals in Intensive Care bundles mainly for managing of broader as well as various range of circumstances in the times of the future
Components of care bundles:
The main components of the care bundles are comprising of a group of 3 to 5 evidence based interventions that relate to a specific type of ailment as well as an event in care of the patient and they should be able to be implemented together while providing care. These interventions should be followed for every patient at all possible time and should be able to be used for perfect assessment of evidence-based practices. The care bundle should be such that every step should be able to be audited in the three categories of done, not done and local exclamation. Bundle should only receive compliance once all the interventions are completed or if a step is excluded for predefined reasons.
Care bundles are helpful or hindrance:
It is very important to evaluate that whether the care bundles are effective or not and for that two important steps need to be taken. The first step is considering the elements of the various types of fundamental theory needs as well as to prove whether it is effective in practice or not. Researchers have stated that it is indeed one of the most important requirements in the carer bundle that every of the patient in a specified group should be receiving all elements of required care. This overall results in an increase in the level of care. Researchers have clearly stated that the concept is mainly based on the assumption that that an unvarying procedure for the delivering of evidence-based high impact interventions which will in turn decrease unjustified dissimilarity in care (Deborah L Horner 2012). In order to decrease the mobility and mortality, different types of unrecognized omissions of clinical care as well as human error or local differences in practice was taken. This has a number of benefits as this process helps in encompassing staff education in best of the practices and has direct benefit to the patient. They also help in shorter Intensive Care Unit stay and thereby decrease financial cost. It also helps in improvement of the resource utilization that in turn benefits the other patients outside the scope of care bundles.
From the above discussion, it becomes clear that there is a strong base for the extensive incorporation of care bundles in the critical care medicine. Different types of researchers have evaluated the success as well as the efficiency of critical care bundles. In such articles there have been a high degree of compliance found along with the care manuals. Therefore, we one can conclude that care bundles have shown effective outcomes and have the potential to become more successful in the future.
References:
1 Continuing Education in Anaesthesia Critical Care & Pain, Volume 12, Issue 4, 1 August 2012, Pages 199–202, https://doi.org/10.1093/bjaceaccp/mks021
Published: 09 May 2012
PART 2
Discussions were conducted with fellow students. After the discussion, their feedback were taken from workplace practices on the utilization of care bundles in Intensive Care units. This proved that greater patient recovery rates were associated with Effective utilization of care bundles. Reduce complications as well as reduce length of stay in the ICU were also effective outcomes. The main theory that was found to reside behind the use of care bundle is that when an large number of evidence based interventions are put together and grouped, so that a single protocol implementation can be carried out, it results in better enhancement of the patient health as well as speedy recovery of this patient. One of the commonly used type of the bundles in the ICU is the ventilator care bundles. It mainly includes elevation of the head of the bed two angles between the range of about 30 and 45 degree. It also included daily sedation interruption assessment of the readiness for the successdul extubation as well as peptic ulcer disease, venous thromboembolism prophylaxis as well as peptic ulcer disease prophylaxis. Some other examples are line bundles catheter bundles as well as sepsis care bundles (Bouadma L, 2010).
Analysis of a study showed that after introducing a ventilation care bundle, the incidence of one type of pneumonia was the ventilator-associated pneumonia and was seen to undergo reduction by 51% over a period of 2 years. Some of the elements of the bundle comprise of proper hand hygiene, use of gowns as well as gloves during the performance of the interventions, effective adoption and management of semi recumbent position. It also involve meticulous attention to different correct tracheal cuff pressure, good oral hygiene, elimination of unnecessary placement of nasogastric tube, effective care for providing gastric distention, good oral hygiene as well as to avoid that brachial functioning other than when essential.
Surviving sepsis is one of the most significant as well as widely accepted care bundles in Intensive Care Unit. This is mainly seem to be comprising of the reservation as well as ongoing care components that incorporate effective monitoring of the serum lactate levels. It also involves taking of blood cultures mainly in the time before the giving of various antibiotics, as well as broad spectrum antibiotics that have to be given within 3 hours of A and E admission. They should be also given within 1 hour of non A and E admission with effective treatment of hypotension as well as elevated lactate level with Fluids (FAuthor, 2013). It is also seen to comprise of vasopressors for hypotension not responding to initial fluid resuscitation. This helps to keep the mean arterial pressure greater than 65 millimeter of mercury. He also helps to keep the cvp greater than 8 millimeter of Mercury and has low dose like hydrocortisone for 7 days. This is mainly done in clients who suffer from refractory low atrial pressure despite the adequate fluid as well as vasopressors. Glucose control is commenced If the blood sugar level is greater than 10 mmol/litre (Lagan S, 2011).
Researchers such as Levy and colleagues have conducted evaluation of the effectiveness of the surviving sepsis guidelines. It was seen that compliance with the management bundle had shown steady improvement from the time of 18.4% to 36.1%. Researchers like Lagan and his colleagues had published an online audit in the year 2008 in the month of August with suggested the 96% of the units were using ventilator care bundles and 68% of those units were seen to achieve 84% as well as better compliance.
FAST HUG can be defined as the implementation of a collection of interventions as well as clinical practices for proper caring of critically ill patients who are residing in Intensive Care units worldwide. It was also made a part of many care bundles and mainly helps in providing faster recovery and reduction of the complications as well as length of stay of the patients in ICU. This is mainly seen to include a number of aspects like early start of feeding, appropriate sedation and sedation hold, adequate analgesia, head of bed angle, thrombo-prophylaxis, ulcer prophylaxis as well as glucose control. Regularly reviewing these elements mainly helps in enhancement of the safety as well as well as quality care of the patient in ICU unit
Care design seems to have proven to be effective in improvement of the clinical outcomes. It is significant for every healthcare professional to know the best Strategies for implementing in clinical care. a number of reports in Literature have been provided which has helped to evaluate the success as well as effectiveness of critical care bundles along with implementation with a high degree of compliance. It has been found that they have been considerate reductions in morbidity and mortality of patients. Therefore, it remains a responsibility of Critical Care community for the development refining and updating the bundles by taking help through properly evolving different types of clinical evidence and thereby to continue with research evidences and adopt best practices for Intensive Care units
References:
1 FAuthor: P Fulbrook, RN, MSc, PGDE, BSc (Hons), Clinical Reader in Critical Care, Institute of Health & Community Studies, Bournemouth University, Bournemouth, Dorset; S Mooney, RN, MSc, PGDip, Consultant Nurse in Critical Care, Dorset County Hospital, Dorchester, Dorset … Less ASTHUG for intubated and ventilated patients intensive care units practiced in worldwide.
2 BouadmaL, Mourvillier B, Deiler V, et al. A multifaceted program to prevent ventilator-associated pneumonia: impact on compliance with preventive measures, Crit Care Med, 2010, vol. 38 (pg. 789-96) https://doi.org/10.1097/CCM.0b013e3181ce21af
3 . Levy MM, Dellinger RP, Townsend SR, et al. The Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis, Intensive Care Med , 2010, vol. 36 (pg. 222-31) https://doi.org/10.1007/s00134-009-1738-3
4 Lagan S. National Care bundles audit Available from https://www.midtrentccn.nhs.uk/service-improvement/care-bundles (accessed 2 April 2018)
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