CNA770 - The Role of Care Bundles in Critical Care Nursing Practice

This essay provides a comprehensive analysis of care bundles in critical care nursing, addressing whether they are helpful or a hindrance. It begins by defining care bundles and their role in ensuring minimum standards of care. The essay then examines the use of sepsis care bundles as an example, discussing their components and impact on patient outcomes. It evaluates the effectiveness of care bundles, considering their theoretical underpinnings and practical application. The essay also incorporates discussions with fellow students and feedback from workplace practices, highlighting the association between effective care bundle utilization and improved patient recovery rates. Furthermore, it explores specific types of care bundles used in ICUs, such as ventilator care bundles and FAST HUG, emphasizing their components and benefits in reducing complications and length of stay. The essay concludes by affirming the importance of care bundles in critical care and the need for continuous development and refinement based on evolving clinical evidence. Desklib provides access to this and many other solved assignments.

Running head: CARE BUNDLES
CARE BUNDLES
Name of the student:
Name of the university:
Author note:

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Assessment 1: CNA770 Foundations of Critical Care Nursing Practice
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

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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.

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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

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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
2. BerenholtzSM, Dorman T, Ngo K, Pronovost PJ. Qualitative review of intensive care unit
quality indicators, J CritCare , 2002, vol. 17 (pg. 1-12) https://doi.org/10.1053/jcrc.2002.33035
3. Patient Safety First Critical Care Interventions Available from
http://www.patientsafetyfirst.nhs.uk/Content.aspx?path=/interventions/Criticalcare/ (accessed 23
August 2011)

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Assessment 1: CNA770 Foundations of Critical Care Nursing Practice
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

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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.

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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

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... 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 http://www.midtrentccn.nhs.uk/service-
improvement/care-bundles (accessed 2 April 2018)

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Appendix 1:
What is the most appropriate weaning from ventilation strategy for the long – term
ventilated patient?
Weaning strategies for long-term ventilator patients:
It is extremely important for the healthcare professionals to take steps that would ensure short
stay of the patients in the ventilator support. Weaning can be described as the gradual procedure
by which decrease in the ventilator support can be ensured. Duration of the entire process of
mechanical ventilation is associated with the weaning procedure. Delayed weaning can result in
the various types of complications like the ventilator-associated pneumonia (VAP), ventilator
induced lung injury (VILI) as well as the ventilator induced diaphragmatic dysfunction.
Researchers are again of the option premature weaning may lead to different types of issues and
complications like defective gas exchange, loss of the airway, aspiration and respiratory muscle
fatigue (Elliot & Morrell-Scott2014).
First thing to think what is the reason for the ventilator support?
Clinician-imposed factors:
This is mainly seen to include the delay of the clinician in effective recognizing of the ability of
the patient to have mechanical ventilation discontinued. It may also include inappropriate

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ventilator settings that are seen to overload as well as under load different respiratory muscles
and preventing recovery (Esteban A, 2008 177).
Disease-imposed factors:
This is mainly seen to include mechanical as well as issues with gas exchanges that continue to
require the need of PPV.
APPROACH TO DIFFICULTY WEANING AND THE PROLONGED MECHANICAL
VENTILATION PATIENT:
They are mainly seen to aggressively require the help and treatment of different reversible causes
of the ventilator dependence helping in the optimizations of different factors. These factors are
mainly seen to include Electrolytes and metabolic derangement, Neuromuscular disease and
weakness, Nutrition insufficiency, Thyroid disease, Anxiety, Sepsis, Opiates and other sedatives,
Heart disease and fluid overload and Wheeze (especially COPD and asthma) El-Khatib 2008)
Researchers are of the opinion that a very careful evaluation of the requirements and the needs
for the procedure of the ongoing ventilator support should be coupled with approach of the daily
reassessment for the appropriate use of the repeat SBT (spontaneous breathing trial). Healthcare
professionals should not perform the process of SBT more than often on a daily basis (i.e. q24h)
so as to prevent the occurrence of fatigue. The multidisciplinary team members should provide
importance in optimisation of the all-important aspects that contribute to the ventilator

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dependence. This may include psychosocial support, physiotherapy as well as nutrition. The
professionals should take approach in the slow paced gradual reduction in the ventilation support
for patients who are living with prolonged mechanical ventilation. The patients should be
weaned to about 50% of the maximal support levels, which is about 50% of their initial
inspiratory pressure without using the daily SBTs (MacIntyre NR 2013.)
. When such objective gets achieved, the professionals should take part in gradual lengthening of
the daily SBTs which should be reinstituted. The patients should be also considered for
tracheostomy, if they are seen to remain intubated for >7-14 days. However, one should always
know that the successful as well as effective ventilator discontinuation and extubation entirely
depends on the condition of the patients. The professionals should always keep in mind that they
should consider the medical condition of the patients like anaemia, disease resolution, nutrition,
conditioning, and many others. They should also keep in mind about the protection of the
airways post extubation which may include separation from weaning assessment and extubation
assessment..
References:
1 Esteban A, Ferguson ND, Meade MO, Frutos-Vivar F, Apezteguia C, Brochard L, et al.
Evolution of mechanical ventilation in response to clinical research. American journal of
respiratory and critical care medicine. 2008;177 /1972267113/3c7242c02602428APQ/3?
accou...> 2):170–7. [PubMed]
2 (Elliott, S & Morrell-Scott, N 2014, `Care of patients undergoing weaning from mechanical
ventilation in critical care’, Nursing Standard, vol.32, Iss. 13, viewed 22 November 2017, Health
&Medicine, <http://search.proquest.com.acs.hcn.com.au/health/docview