Title:
Effect of feedback on ventilator care bundle compliance: before and after study.

Abstract:
Care bundles cluster together several evidence-based practices and, in the intensive care setting, the ventilator care bundle (VCB) has been applied widely.
To determine the effect of monthly feedback on VCB compliance.
Before and after study: primary outcome measure VCB compliance.
Data were collected for 1 year from two metropolitan general intensive care units (ICU) on one randomly allocated day per week. Baseline data from adult ventilated patients were collected during the first 6 months (phase 1). During the second 6 months (phase 2), monthly compliance data were provided to each ICU regarding both ICUs' performance.
Both 'all or nothing' compliance (when all four VCB elements were complied with) and overall compliance (the average compliance of the four elements) increased between the two phases. These increases were mostly small and statistically insignificant. Although both measures increased in ICU B, both fell in ICU A. ICU B's overall compliance increase was statistically significant (p = 0·005), but its 'all or nothing' compliance increase (19%), whilst arguably clinically significant, did not reach statistical significance. ICU B achieved increased compliance with all four VCB elements in phase 2, whereas ICU A achieved increases in two elements (deep vein thrombosis and gastric ulcer prophylaxis). Both ICUs achieved 100% compliance with gastric ulcer prophylaxis for all of phase 2. Head of bed elevation was the least complied with element in phase 1, and increased in ICU B only in phase 2.
Although the compliance rates with individual elements are encouraging, the results regarding the effect of feedback on VCB compliance were variable. The finding of relatively poor compliance with head of bed elevation is consistent with previous research.
Further research is needed to determine the effects of audit and feedback, and which strategies are most effective.