Cooke Fiona J, Holmes Alison H
Department of Infectious Diseases and Immunology, Hammersmith Hospitals NHS Trust, Imperial College, Du Cane Road, London W12 0HS, UK.
Int J Antimicrob Agents. 2007 Jul;30(1):25-9. doi: 10.1016/j.ijantimicag.2007.03.003. Epub 2007 May 11.
The care bundle involves grouping together key elements of care for procedures and the management of specific diagnoses in order to provide a systematic method to improve and monitor the delivery of clinical care processes. In short, care bundles aim to ensure that all patients consistently receive the best care or treatment, all of the time. This approach has been successfully applied to the management of various conditions, particularly in the critical care setting. The Institute for Healthcare Improvement's '100K lives campaign' consisted of six care bundles, three of which have addressed preventing hospital-acquired infection. The UK Department of Health's delivery programme to reduce healthcare-associated infections (HCAIs), including methicillin-resistant Staphylococcus aureus (MRSA), includes six 'high-impact interventions', which are care bundles to reduce HCAIs. However, we suggest that one key intervention is missing, and consider this intervention will be increasingly important if hospitals are to address the rising incidence of Clostridium difficile, to tackle antibiotic resistance and to improve patient care. The missing intervention addresses the process of antibiotic prescribing. We propose that the time is right to consider the application of the care bundle approach to improve the prescribing of antibiotics, both for treatment and prophylaxis.
护理包涉及将针对特定诊断的程序护理的关键要素组合在一起，以便提供一种系统的方法来改进和监测临床护理过程的实施。简而言之，护理包旨在确保所有患者始终都能持续获得最佳护理或治疗。这种方法已成功应用于各种病症的管理，尤其是在重症监护环境中。医疗保健改进研究所的“10万生命运动”包含六个护理包，其中三个涉及预防医院获得性感染。英国卫生部旨在减少包括耐甲氧西林金黄色葡萄球菌（MRSA）在内的医疗保健相关感染（HCAIs）的实施计划包括六项“高影响力干预措施”，这些都是用于减少HCAIs的护理包。然而，我们认为缺少一项关键干预措施，并且认为如果医院要应对艰难梭菌发病率上升、解决抗生素耐药性问题并改善患者护理，这一干预措施将变得越来越重要。缺失的干预措施涉及抗生素处方流程。我们建议，现在是考虑应用护理包方法来改善抗生素治疗和预防处方的时候了。
