Table 1

Feedback received over the course of the project

Baseline
  1. Initial format of sticker took up too much space in the notes.

  2. Response (SHOUT) and review (BUMP) elements should be separated into two separate stickers, with the bundle having initially been combined into one.

  3. Stickers would be best located in the doctor’s room.

Week 1
  1. Bundle was simple and easy to use.

  2. There was debate as to whether it altered how the clinician would have managed the patient anyway.

Week 2
  1. There was concern among staff that the bundle gave misleading advice on gentamicin prescribing. The bundle initially advised that gentamicin not be used in all patients with an acute kidney injury (AKI), whereas guidelines permit the use in patients with AKI 1 and 2.

Week 3
  1. Staff fed back concerns of ‘bundle fatigue’—there were 22 different care bundles or checklists in total on acute medical unit.

Week 4
  1. There was not a belief that the sticker altered practice and therefore no real incentive to continue use.