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請問先進~

102/6底至醫院查核委員提及肺炎、導尿管相關之Bundle 查核表單，

於學會內網站未見著，查核當日委員提及已完成並掛網使用；

致電詢問學會和馬偕醫院說明未討論成形。

請問委員建議如何著手實施導尿管相關(101年8月份已查閱文獻訂定院內導尿管查核，委員不予認同，批評指導；積極全院參與Bundle，但因委員不認同，如今待主管裁示是否繼續做或是以單位區分施行)?

請先進給予相關建議，感謝您！

6556 發表於 2013-07-02 08:16:24 回覆

學妹好

學會目前有掛網的資料是CVC care bundle 其他如 FOLEY 或VAP BUNDLE 是今年學會的科技研究計畫；需待小組成員討論執行後成效分享；定稿後才會掛網

不知道未何委員認為您的設計不是BUNDLE ,BUNDLE 的表單設計有他的原則性

可參考國外的資料或國內在感控雜制有發表的文獻；抓住CARE BUNDLE的精神就不會錯

以下文獻供參考

What is a bundle?

原文：A bundle is a structured way of improving processes of care and patient outcomes.

"Bundles" have emerged as frameworks for addressing clinical healthcare conditions with evidence-based practices.

中文：bundle是一個結構化的方式改善護理和病人治療效果的過程。
Bundle 基於證據的做法解決臨床醫療條件。

原文：A bundle is a set of interventions (usually 3 to 5), when grouped and implemented together, promote best outcomes with a greater impact than if performed individually

中文：組合式照護的介入策略通常 3-5個；普遍實施成組照護效果比單獨照護介入來的好

原文：when planning bundle-based care, each aspect be well defined and based on evidence from at least 1 systematic review of multiple well-designed randomized controlled trials (RCT) or on data from at least 1 well-designed RCT

中文：當規劃組合式照護時，每個方面至少有1多個精心設計的隨機對照試驗的系統回顧（RCT）或從數據上明確界定，並根據證據至少有1精心設計的隨機對照試驗

原文：ICUs can create customized protocols to standardize the implementation of bundle care components.

A primary benefit of bundle care is the structuring of care processes to promote consistency(一致性) in the management of clinical conditions using evidencebased practices.

中文：加護病房可以創建實施組合式照護的規範。

組合式照護主要優點在護理過程的結構中，使用evidencebased做法以促進在臨床管理的一致性。

原文：Studies reporting the impact of implementing bundles to prevent central line infections and urinary tract infections have highlighted the importance of both a focused approach to implementation and periodic evaluation of adherence to the bundle components

中文：強調集中的做法的重要性，遵守組合式照護的實施和定期評估。

Who can use the bundles?

n Anyone in any clinical setting with the agreement of the clinical team leaders can use the bundles.

n However , infection control teams will be able to offer support with regard to implementation and advice on data collection, analysis of data and feedback.

中文：任何人在任何臨床裝置經臨床團隊的領導人同意，可以使用組合式照護。

然而，感染控制小組將提供支持，對執行情況數據的收集和建議、分析和回饋。

What are “ care Bundle”？

l All clinical staff know that these interventions are best practice but frequently their application in routine care is inconsistent

l (所有臨床工作人員都知道，這些介入措施是最佳策略，但經常在日常護理的應用是不一致的。)

n A Care Bundle is a means to ensure that the application of all the interventions is consistent for all patients at all times thereby improving outcomes.

n 組合式照護是一種手段，確保所有的病人不論在任何時候 ，所有的介入措施的應用改善成果是一致。

What are the types of bundles

• Central Vascular Catheter Maintenance Care Bundle and checklist

• Catheter Associated Urinary Tract Infections Bundle and checklist

• Peripheral Vascular Catheter Care Bundle

• Surgical Site Infection Prevention Bundle

• Clostridium difficile Infection Care Bundle

• Maintenance bundle for use in the Community

• VAP Bundle (external link to PDF document) is available on the Scottish Intensive Care Society Audit Group

• website：http://www.hps.scot.nhs.uk/haiic/ic/bundles.aspx

• 學妹如有問題； MAIL 您的資料給我；我幫您看一下：看是不是您設計的變成護理技術的格式；委員才會說不是

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