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February 2011, Volume 41 Number 2 , p 19 - 21


  • Catherine E. Whelchel MHSA, RN, CNAA-BC
  • Mary F. Pynn MS, RN, NEA-BC
  • Susan E. Lizakowski BSN, RN


PROVIDING HIGH-QUALITY care for inpatients is becoming increasingly complex. Organizations such as the National Quality Forum, Centers for Medicare and Medicaid Services, the Institute for Healthcare Improvement (IHI), and the Agency for Healthcare Research and Quality (AHRQ) all publish evidence-based practice protocols designed to drive improvements in patient-care outcomes.The transition to results-based care and greater public awareness of outcomes has increased hospitals' focus on quality bundles associated with evidence-based protocols. According to the IHI, "a bundle is a group of interventions related to a disease process that, when executed together, result in better outcomes than when implemented individually."1Quality bundles give nurses more to do in a specific time frame without providing extra support or opportunities to assess compliance. Nurses experience complexity compression when they're expected to take on extra duties while conducting many tasks in a shorter period.2 At the same time, research and evidence grows continually, requiring the implementation of additional best practices at the bedside.Although ultimately we intend to reduce complexity and improve bundle compliance, this article focuses on understanding the volume of bundles that patients are placed on today. We include suggestions to help deal with the problems of using multiple bundles.In 2009, three of HealthEast Care System's four hospitals in the St. Paul-Minneapolis, Minn., area undertook a study to better understand the use of quality bundles on its critical care units. The system comprises 500 staffed beds and four ICUs. The study involved medical-surgical, neurology, and cardiovascular ICUs, with telemetry beds intermingled on some units.To reduce the cognitive burden on RNs and other healthcare professionals, the HealthEast hospitals are piloting an electronic concurrent monitor of the status of ventilator-associated pneumonia (VAP) prevention bundle metrics. The monitor provides

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