Marwick Charis, Davey Peter
Quality and Safety Improvement Research Group, Division of Community and Population Sciences and Education, College of Medicine, Dentistry and Nursing, University of Dundee, Dundee, Scotland.
Curr Opin Infect Dis. 2009 Aug;22(4):364-9. doi: 10.1097/QCO.0b013e32832e0736.
A care bundle is set of four or five processes that each individually improve patient outcome and that should be performed together for every patient every time. We describe how bundles should be designed, implemented and evaluated with measurement designed for quality improvement rather than research or judgement.
A systematic review concluded that the relative risk reduction associated with the introduction of a sepsis bundle exceeded 25%, and absolute risk reduction exceeded 9% in all studies. The number needed to treat to save one life in each study population ranged from three to 11. Bundles for the prevention of infections have focused on ventilator-associated pneumonia and catheter-associated bloodstream infections in the ICU. The most persuasive evidence of effectiveness comes from multicentre studies, but results from single ICUs provide valuable insights into how bundle implementation fits within a broader quality improvement strategy.
Care bundles can be a powerful driver for improving the reliability of delivery of evidence-based care and patient outcomes. It remains to be seen whether the success that has been achieved in acute admissions and ICUs can be reproduced in general wards.
护理集束是一组四到五个流程，每个流程单独实施都能改善患者预后，并且每次都应对每位患者一起执行。我们描述了护理集束应如何设计、实施和评估，采用旨在提高质量而非用于研究或评判的测量方法。
一项系统评价得出结论，在所有研究中，引入脓毒症护理集束相关的相对风险降低超过25%，绝对风险降低超过9%。在每个研究人群中，拯救一条生命所需治疗的患者数为3至11人。预防感染的护理集束主要针对重症监护病房（ICU）中的呼吸机相关性肺炎和导管相关性血流感染。最具说服力的有效性证据来自多中心研究，但单个ICU的结果为护理集束实施如何融入更广泛的质量改进策略提供了有价值的见解。
护理集束可以成为提高循证护理提供的可靠性和患者预后的有力推动因素。急性入院患者和ICU中已取得的成功能否在普通病房再现仍有待观察。
