Critical care bundles

1. Mrs.K.S.Pushpalatha, Ph.D.(N),
Staff Nurse,
GMKMCH, Salem.

2. What is meant by Care bundle?
Care bundles are a set of three to five
evidence-informed practices performed
collectively and reliably to improve the
quality of care.

3. Meaning of Quality care
 Quality care is the measure of how well
health care services work to provide a
positive or desired outcome for patients.
Difference between Quality and Safety
 Quality is about ensuring products or services
meet or exceed customer expectations, while
safety is about protecting people and the
environment from harm.

4. Best practices for delivering quality
patient care
 Show respect. ...
 Express gratitude. ...
 Enable access to care. ...
 Involve patients' family members and friends. ...
 Coordinate patient care with other providers. ...
 Provide emotional support. ...
 Engage patients in their care plan. ...
 Address your patients' physical needs.

5. Our Objective is ,
The very first
requirement in a
hospital is that it
should do the
sick no harm.
Checklist
Protocols
Care bundles
Audits
Quality rounds
Equipment
cleaning
Calibration
Linen quality
Seven “R’s in Drug administration
Drug management
Consent
Records
Staff skill
Cleanliness

6. EBP/ EIP
 EBP: Evidence-based practice refers to the
process of using the latest and most
relevant evidence to guide decisions
related to Patient care.
 EIP: Evidence-informed practice relies on
the use of the best available research, it
typically involves the implementation of a
facility-wide program.

7. Protocol vs Care Bundle
 Clinical Protocol: Clinical protocols are
basically rules of how to proceed in certain
situations.
 Care Bundle: Care bundles are a set of care
practices that are carried out together (as a
bundle) when delivering care to patients with the
same condition or in the same healthcare setting

8. Meaning of Checklist
Checklists in healthcare are defined
as lists of actions arranged
systematically that allow the user to
consistently perform each action,
record the completion, and minimize
errors.

9. CARE bundle / Bundle care
Care bundles are a set of 3 to 5
evidence-informed practices
performed collectively and reliably
to improve the quality of care.

10. Examples of Care bundle
 ICU care bundles
 Sick newborn care bundles
 LBW baby care bundles
 PPH care bundle
 Severe Hypertension care bundle
 Obstetric Hemorrhage care bundle

11.  SSI Care bundle
 Covid care bundle
 Post LSCS care bundle
 Preterm labour care bundle
 Eclampsia care bundle
 Vaginal delivery care bundle
 Sepsis in Obstetrical Care

12. ICU care bundles
TYPES OF CARE BUNDLES
CLABSI VAP CAUTI

13.  Central line-associated bloodstream infections (CLABSI)
Insertion Bundle: -
Maximal sterile barrier precautions (surgical mask,
sterile gloves, cap, sterile gown, and large sterile drape).
Skin cleaning with alcohol-based chlorhexidine (rather
than iodine).
Avoidance of the femoral vein for central venous access in
adult patients; use of subclavian rather than jugular
veins.
Dedicated staff for central line insertion, and
competency training/assessment.
CLABSI Care
bundle

14.  Maintenance Bundle: -
Daily review of central line necessity. - Prompt removal
of unnecessary lines.
Disinfection prior to manipulation of the line.
Daily chlorhexidine washes (in ICU, patients > 2
months).
Disinfect catheter hubs, ports, connectors, etc., before
using the catheter.
Change dressings and disinfect site with alcohol-based
chlorhexidine every 5-7 days (change earlier if soiled).
 Replace administration sets within 96 hours
(immediately if used for blood products or lipids).
 Ensure appropriate nurse-to-patient ratio in ICU (1:2
or 1:1).

15.  CATHETER INSERTION:
 Perform hand hygiene
Perform perineal-care
 Re-perform hand hygiene
 Maintain strict aseptic technique
 Insert catheter to appropriate length and check
urine flow before balloon inflation . Inflate balloon
correctly (5-10 cc)
 Secure catheter tubing to leg with securement
device
 Re-perform hand hygiene upon completion
CAUTI Care
bundle

16. Urinary catheter Maintenance
 Maintain unobstructed urine flow: no kinks, twists,
or loops in the tubing
 Keep the collection bag below the level of the
bladder at all times without ever resting bag on the
floor
 Maintain a closed drainage system at all times
 Empty bag regularly and keep bag under ¾ full at
all times
 Use individual, labeled collection container for
each resident
 Do not let drainage spigot touch the container (or
floor)

17.  Attach catheter tubing to leg with
securement device
 Perform hand hygiene prior to and after
catheter contact
 Perform daily perineal care with soap and
water and when soiled
 Review necessity of catheter regularly and
remove promptly when resident does not
meet approved indications

18. Head end to be elevated atleast to 30
degrees
Daily sedation interruption with readiness
to wean assessment
Peptic ulcer disease prophylaxis
Deep vein thrombosis prophylaxis
Thorough daily oral care with subglottic
suctioning
VAP Care
bundle

19.  Respectful maternal care
 Using SBC 1, 2, and 3
 Allowing Birth companion
 Counselling of Birth companion
 Dress change of mother and BC in labour
 Preparation of Labour table, trays, NBCC
 Monitoring of Partograph( Three P’s)
 Awaiting for Five imminent signs of vaginal delivery
 Following EIP in delivering baby (Ten Don’ts and Six
Cleans, AMTSL) and provide ENBC
Vaginal delivery care bundle

20. Bundle Care of Hypertension in Pregnancy
 Monitoring of BP chart on every Half an hour , then 2nd
hourly.
 T.Labetalol , Stat dose if diastolic BP> 90 mmof Hg
after two times reading with same position and same
apparatus.
 MgSo4 regimen loading dose if imminent Signs present
 Maintenance dose till 24 hours , along with T.Labetalol
administration
 Monitoring of urine albumin and BP under observation.

21. PPH bundle care
First response PPH bundle
 Inj.Oxytocin 20 units as 10 units in 500ml RL
 Two IV cannulation and fast fluid resuscitation
 Tranexamic acid
 Uterine massage
 T.Misoprozol 800 mikes per rectum
 Find the cause for Four “T’s: Tone/Trauma/Tissue/ Thrombi
 If due to trauma, Suture it
 If tissue, remove it manually
 If Atonic uterus, follow refractory management of PPH as
follows

22. Response to refractory PPH bundle
Compressive measures (aortic
compression or bimanual uterine
compression)
Intrauterine balloon tamponade
Non-pneumatic antishock garment(NASG)
SR cannula

23. Care bundle for Birth Asphyxia
 No breast feed
 Admit in SNCU
 Monitor SpO2 and RR
 Start IV fluids
 Keep NPO
 Provide Warmth
 Monitor CRT/ CBG/HR/S.Calcium
 Monitor Sarnat chart
 Observe for any signs of fit
 Monitor intake and output chart
 Therapeutic hypothermia (Miracradle ) 72 hrs
(exclude babies with shock, preterm, Sepsis and
bleeding disorder)

24. Care Bundle for LBW/Preterm
 Admit in SNCU
 Monitor SpO2 and RR
 Start IV fluids
 Keep NPO
 Provide Warmth/KMC by care giver/Parent
 Family Participatory care
 Infection control practices
 Observe for Sucking/Swallowing reflex
 NG tube feeding
 Initiate Paladai feeding as per requirement
 Slowly start DBF

25. (a) TH initiated(Therapeutic Hypothermia)
(b) central venous pressure/central venous
oxygen saturation monitoring in 2 h
(c) target temperature in 4 h
(d) central venous pressure greater than 12
mmHg in 6 h
(e) MAP greater than 65 mmHg in 6 h
(f) central venous oxygen saturation greater
than 70% in 6 h
(g) TH maintained for 24 h and (h) decreasing
Post-cardiac arrest care bundle

26. Pressure ulcer care bundle
The SSKIN Model
 Surface: Make sure your patients have right support.
 Skin inspection: Early inspection means early
detection. Show patients and carers what to look for.
 Keep patients moving.
 Incontinence/Moisture: Your patients need to be clean
and dry.
 Nutrition/Hydration: Help patients have the right diet
and plenty of fluids.

28. THANK YOU