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Care Bundle
A bundle is a collection of elements (usually between 3 to 5) that are applied to a selected group of patients/clients.

What is a bundle?

 

A bundle is a collection of elements of care (usually between 3 to 5) that are applied to a selected group of patients/clients. In this case, this bundle is applied to those judged at risk of developing a pressure ulcer or who have a pressure ulcer. The bundle is not the same as a checklist, as it is distinct in several ways:

 

  • All elements in the bundle are based on robust evidence. Often in routine clinical practice, not all elements are carried out at the same time or in the same way. This means there is variation in patient/client care and ultimately in care outcomes.

 

  • To be successful, all the elements of the bundle should be carried out together and at the same time. (e.g. at the patient’s bedside at 2 hourly intervals).

 

  • Delivery of the bundle is measured through compliance with every element. This can be easily identified by a simple ‘Yes’ or ‘No’ approach. This is an ‘all or nothing’ approach. For the purpose of measuring how well you have complied with the bundle you may have to count in a way that is appropriate to the bundle. For example, if one of the bundle elements could not be applied to a particular individual for a particular reason (for example they are under a pre op ‘nil by mouth’ arrangement, or if an individual refuses to move or is off the ward, you can indicate this with use of a symbol agreed by your team (i.e. R = refused, O = out) then simply document this action as having been appropriately performed.

 

  • Improvement experts argue that better outcomes are achieved when interventions are carried out together rather than individually. The aim of this bundle is to tie best practices together in a reliable way to reduce the occurrence of a pressure ulcer.

 

  • The bundle encourages attention to detail through its individual elements and helps establish good habits which ultimately impact on outcomes (i.e. reduce pressure ulcers). The bundle therefore makes it easy for people to do the right thing at the right time. Most importantly, the bundle makes the process for preventing pressure ulcers visible to all.

How to use this tool well

We are currently testing this bundle within a small number of sites across Scotland. Initial testing of the bundle, and discussions with colleagues outside of Scotland, has highlighted that the element of skin inspection (accounting for the second ‘S’ – SSKIN) should be brought to the fore. Should you wish to use this tool, remember to store your data (for example using the monthly safety cross) in a file. You will then have the information you need to see if a positive change has happened as a result of using the bundle.


The test sites have been working hard, and have helped to develop the documentation aspect of the SSKIN care bundle. We now have the latest version of the bundle for you to use.

Remember that improved care can only happen if the whole team is involved and connected to the improvement aim. 
 

What is the aim of the SSKIN bundle?

 

The aim of this bundle is to tie best practices together in a reliable way to reduce the occurrence of a pressure ulcer.

 

The components of the SSKIN bundle are:

    • Surface (appropriate)
    • Skin inspection (pressure areas)
    • Keep moving (encourage/assist)
    • Incontinence (bladder/bowels)
    • Nutrition (food/fluid)
Published Date
23/08/2010
Associated Documents
MS Word document August 2010 Care Bundle Guidance v0.03 (64.512 KB)
MS Word document August 2010 Care Bundle v0.03 (173.056 KB)
Care Bundle Use this Tool well

Key points to remember:

 

  • The frequency to which the bundle is carried out is determined by individual patient/client need.

 

  • All elements of the bundle are standard. However the detail of an element will vary according to each patient/client.

 

  • You are encouraged to ‘tick’ the relevant boxes on the recording sheet to evidence that you have addressed all elements. Remember, it is good practice to document any variance.

 

  • Not all patients/clients who will benefit from the care bundle will necessarily be incontinent, have poor nutrition or have limited mobility. Nor will they necessarily require every element at every point; it is a prompt however to remember to ask. However, giving due care and attention to these elements will ensure that the occurrence of a pressure ulcer is minimized.