Making Sense of Evidence-Based Practices

Bundling evidence-based practice theory with products and implementation guidance has become an increasingly popular and effective way to ensure interventions are implemented in a comprehensive way. The concept of care bundles was created during the VHA-sponsored Idealized Design at Intensive Care Unit (IDICU) innovation project, which identified the need to improve care for ventilated patients as a priority in the ICU. (Joint Commission, 2006)

Fulbrook and Mooney (2003) note that the theory behind care bundles is that when several evidence-based interventions are grouped together in a single protocol, it will improve patient outcomes. They add that care bundles are relatively easy to develop, implement and audit, and provide practitioners with a practical method for implementing evidence-based practices.

“I think bundles are a terrific means to take the most important recommendations, put them together, and combine them with practical and effective means to ensure compliance and sustainability — like the checklist,” says Rupp.

Carol Haraden, PhD, vice president and patient safety expert at the Institute for Healthcare Improvement (IHI), a strong proponent of bundling, notes, “IHI developed the concept of ‘bundles’ to help healthcare providers more reliably deliver the best possible care for patients undergoing particular treatments with inherent risks. A bundle is a structured way of improving the processes of care and patient outcomes: a small, straightforward set of practices — generally three to five — that, when performed collectively and reliably, have been proven to improve patient outcomes.”

Haraden adds, “The power of a bundle comes from the body of science behind it and the method of execution: with complete consistency. It’s not that the changes in a bundle are new; they’re well established best practices, but they’re often not performed uniformly, making treatment unreliable, at times idiosyncratic. A bundle ties the changes together into a package of interventions that people know must be followed for every patient, every single time.”