Outcomes of Implementing a Care Bundle for the Early Management of Patients with Acute Upper Gastrointestinal Bleeding

Abstract

Background: Care bundles are the most common form of standardizing patient care that can lead to a high quality of care for frequent admission diagnoses. Gastrointestinal (GI) bleeding is still a prevalent and potentially fatal emergency problem that encounters critically ill patients. Critical care nurses play a crucial role in the implementation of standards of care through recognizing the importance of early and timely management as rapid resuscitation and early endoscopy are associated with better outcomes. The British society of gastroenterology emphasized ongoing differences in practice and inadequate management of patients with acute upper GIT haemorrhage. That is why, major initiatives such as the acute upper GI bleeding bundle are still required to address these differences and improve patients' clinical outcomes. Objective: To determine the outcomes of implementing a care bundle for the early management of patients with acute upper gastrointestinal bleeding Setting: This study was conducted in the Hematemesis intensive care unit of Alexandria Main University Hospital, Egypt. Subjects: A convenience sample of 60 newly admitted adult patients with acute upper gastrointestinal bleeding were included in this study. Patients were assigned into two equal groups (30 patients each). Tool: "Assessment of Upper Gastrointestinal Bleeding Bundle Implementation Outcomes" is the tool used to collect the data of this study. Results: There was a statistically significant difference was observed between the study and control groups in the first, second, and third day of MAP readings (p= 0.001, <0.001 and 0.013) respectively. Time waiting until doing the endoscopy was less for the study group compared to the control group with significant difference between both groups. Mortality rate, incidence of rebleeding and length of stay were higher in the control group compared to the study group with no statistically significant differences. Conclusion: implementation of a care bundle for acute upper GIT bleeding patients can lead to improvement of their management and outcomes. Recommendations: Critical care nurses should collaborate with other health team members in the implementation of upper GIT bleeding bundle of care. Hospital administration should conduct educational training to health team members about upper GIT bleeding bundle and its importance in improving patients' outcomes.