Intensive Care Unit (ICU) patients frequently suffer from multi-organ failure and often require advanced life support measures. However, many ICUs struggle with noncompliance on evidenced-based ...guideline recommended practices. Additionally, the interprofessional health care providers often care practices are often siloed and teamwork and collaboration suffer. The purpose of this project is to address this core problem of noncompliance and ineffective team collaboration through an interprofessional unit-wide educational strategy that introduces the concept of these interventions for pain, agitation and delirium in a package called the ABCDEF bundle. This bundle includes these 6 elements: assess, prevent and manage pain (A), both spontaneous awakening trials and spontaneous breathing trials (B), choice of analgesia and sedation (C), delirium: assess, prevent and manage (D), early mobility and exercise (E), and family engagement and empowerment (F). While other studies that have investigated this bundle have both introduced the idea of the bundle and involved widespread protocol changes and the introduction of new procedures, this project introduces just the language and concept of repackaging these elements as a bundle. This project was conducted in an ICU that already had all individual elements of the ABCDEF bundle in place; therefore, the project was uniquely focused on the impact of introducing the concept of bundling those elements and teaching the interprofessional team to use a standard language when discussing patient care. The project focused on the impact of the educational initiative on processes (i.e., compliance with the bundle elements), the people (i.e., teamwork and collaboration), and patient outcomes (e.g., ICU and hospital lengths of stay, hospital discharge location, and first time to ambulation). Baseline measures were obtained prior to the education and then patient compliance and outcomes were tracked for an additional 3 months. This project demonstrated that introducing the ABCDEF bundle in a unit that already had each element in place resulted in improvement in element compliance and teamwork and collaboration. There was no overall effect on patient outcomes. However, it also demonstrated that improvement was marginal and more work with bundle implementation was needed to build on the foundation of improvement. The ABCDEF bundle provides a solid framework for the interprofessional team to flourish and improve in their teamwork and collaboration while delivering quality patient care even in units where the bundle elements are already in place.
The prevention or treatment of pain, anxiety, and delirium in the ICU is an important goal. But achieving a balance between sedation and analgesia, especially in critically ill patients on mechanical ...ventilation, can be challenging. Both under- and oversedation carry serious risks. In 2002 the Society of Critical Care Medicine, along with the American Society of Health-System Pharmacists, updated recommendations in its clinical practice guidelines for the sustained use of sedatives and analgesics in adults. This two-part series examines those recommendations that relate to sedation assessment and management, as well as the current literature. This month Part 1 also reviews pertinent recommendations concerning pain and delirium and discusses tools for assessing pain, delirium, and sedation. In August Part 2 will explore pharmacologic and nonpharmacologic management of anxiety and agitation in critically ill patients. The prevention or treatment of pain, anxiety, and delirium in the ICU is an important goal. But achieving a balance between sedation and analgesia, especially in critically ill patients on mechanical ventilation, can be challenging. Both under- and oversedation carry serious risks. In 2002 the Society of Critical Care Medicine, along with the American Society of Health-System Pharmacists, updated recommendations in its clinical practice guidelines for the sustained use of sedatives and analgesics in adults. This two-part series examines those recommendations that relate to sedation assessment and management, as well as the current literature. This month Part 1 also reviews pertinent recommendations concerning pain and delirium and discusses tools for assessing pain, delirium, and sedation. In August Part 2 will explore pharmacologic and nonpharmacologic management of anxiety and agitation in critically ill patients.
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