Area of care; quality indicator | Evidence grade* | Implementation results reported |
---|---|---|
Mechanical ventilation | ||
Ventilator-associated pneumonia bundle | Moderate to high† | Yes‡ |
Elevation of head of bed | Level 1‡ | |
Daily sedation vacation and assessment of readiness to extubate | Level 1‡ | |
Prevention of venous thromboembolism | Level 1‡ | |
Pressure ulcer disease prophylaxis | Level 1‡ | |
Daily oral care with chlorhexidine | Level 1‡ | |
Pneumonia | ||
Blood cultures performed within 24 hr or before arrival | Evidence synthesis§ | No |
Antibiotics consistent with guidelines | Evidence synthesis§ | No |
Invasive procedures | ||
Ultrasound guidance for central venous catheter insertion | High† | No |
Central line insertion bundle | Moderate to high† | Yes‡¶ |
Maximal barrier precautions | 1B¶; evidence synthesis§ | |
Chlorhexidine skin antisepsis | 1A¶ | |
Hand hygiene | 1B¶ | |
Optimal catheter type and site selection | 1A-1B¶ | |
Central line care bundle | Yes‡¶ | |
Daily review of line necessity | 1A¶ | |
Aseptic lumen access | 1A¶ | |
Catheter site and tubing care | 1B¶ | |
Patient-centred care | ||
Documentation of goals of care | Moderate† | No |
Sepsis management | ||
Sepsis management bundle | ||
Administer low-dose steroids by standard policy | 2C‡** | No |
Maintain adequate glycemic control | 1B‡ | No |
Prevent excessive inspiratory plateau pressures | 1C‡** | Yes** |
Sepsis resuscitation bundle | ||
Serum lactate levels measured | 1B‡ | No |
Timing of blood cultures | 1C‡** | No |
Treat hypotension and/or elevated lactate with fluids | 1B‡ | No |
Maintain adequate central venous oxygen saturation | 1C-2C‡ | No |
Antibiotics given by time goal | 1B‡** | No |
Apply vasopressors for ongoing hypotension | 1C‡ | No |
Maintain adequate central venous pressure | 1C‡** | Yes** |
Patients with sepsis: second litre of crystalloid administered by time goal | 1C** | No |
Blood for culture drawn before antibiotics administered | 1C** | No |
Glycemic control policies | Moderate to high† | No |
After initial stabilization for patients with severe sepsis | 1B** | No |
Validated protocol for insulin dosage adjustments | 2C** | No |
Prevention of adverse events | ||
Appropriate transfusion practices | Not graded | Yes‡ |
Pharmacist on rounds | Moderate to high† | No |
Medication reconciliation by a pharmacist | Moderate† | Yes‡ |
Venous thromboembolism prophylaxis | Evidence synthesis§ | Yes¶†† |
Preventing pressure ulcers | Moderate†; evidence synthesis§ | Yes‡ |
Simulation training | Moderate to high† | No |
Training on infusion pumps | Low† | No |
Infection control | ||
Isolation of patients with resistant infections | Moderate† | No |
Hand hygiene improvement | Low† | Yes‡‡ |
Staffing | ||
Establishment of rapid-response team | Moderate† | Yes‡¶ |
Staffing ratios: increasing nurse to patient ratio to prevent death | Moderate† | No |
*See Table 4.
†Agency for Healthcare Research and Quality.
‡Institute for Healthcare Improvement.
§National Quality Measures Clearinghouse.
¶Canadian Patient Safety Institute.
**Society of Critical Care Medicine, European Society of Intensive Care Medicine.
††Australian and New Zealand Intensive Care Society.
‡‡Health Quality Ontario.