Introduction of a non invasive ventilation (NIV) care bundle in a district general hospital

Introduction : A care bundle is a group of evidence based actions needed to deliver optimal care in a clinical setting. It takes the form of a simple checklist, placed in the notes, which serves as a reminder to clinicians. It aims to ensure consistent delivery of care leading to safe and reliable care. Compliance with all elements is needed for optimum benefit. Method : A 7 item bundle was created for acute NIV. It was introduced to coincide with the 2011 British Thoracic Society (BTS) NIV audit so that the impact could be assessed by comparison with the 2010 audit. The bundle was provided in the form of a sticker to be inserted in the case notes when NIV was commenced. Bundle elements not included in the table below were (1) NIV only to be delivered in areas where nursing staff are trained (2) arterial blood gases checked at 1 hour (3) and at 4 hours (4) review by a pulmonologist within 24 hours (Mon – Fri). Results: 13 of 19 patients (67%) had a bundle in the notes. 11 of 13 (85%) had all 7 elements completed. The impact of the bundle on key measurements are summarised in the table (bundle items highlighted). View this table: Conclusion: Implementation of an NIV bundle is possible in a DGH and coincided with improved audit outcomes, particularly documentation of escalation plans and increased pressures. Numbers are small but it may have contributed to reduced mortality and length of stay.