How to implement monitoring tools for sedation, pain and delirium in the intensive care unit: an experimental cohort study

Radtke, Frank‐Olaf; Heymann, Anja; Franck, Martin; Maechler, Friederike; Drews, Tanja; Luetz, Alawi; Nachtigall, Irit; Wernecke, Klaus‐Dieter; Spies, Claudia

doi:10.1007/s00134-012-2658-1

Cited by 62 publications

(54 citation statements)

References 25 publications

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“…One study, for example, that explored the implementation of sedation, pain and delirium tools found that extended repetitive training led to higher implementation rates than one time training alone. 28 Another possible explanation was that the research team did almost all of the education and monitoring of outcomes. If these changes were initiated and implemented purely by the clinical staff, buy-in may have improved due to an increased sense of ownership.…”

Section: Discussionmentioning

confidence: 99%

Implementing the Awakening and Breathing Coordination, Delirium Monitoring/Management, and Early Exercise/Mobility Bundle into Everyday Care

Balas¹,

Burke

Gannon

et al. 2013

Critical Care Medicine

209

183

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Objective The Awakening and Breathing Coordination, Delirium monitoring/management and Early exercise/mobility (ABCDE) bundle is an evidence-based, interprofessional, multicomponent strategy for minimizing sedative exposure, reducing duration of mechanical ventilation and managing intensive care unit (ICU) acquired delirium and weakness. The purpose of this study was to identify facilitators and barriers to ABCDE bundle adoption and to evaluate the extent to which bundle implementation was effective, sustainable, and conducive to dissemination. Design Prospective, before-after, mixed-methods study. Setting Five adult ICUs, 1 step-down unit, and a special care unit located in a 624 bed, academic medical center Subjects Interprofessional ICU team members at participating institution. Interventions and Measurements In collaboration with the participating institution, we developed, implemented, and refined an ABCDE bundle policy. Over the course of an 18 month period, all ICU team members were offered the opportunity to participate in numerous, multimodal educational efforts. Three focus group sessions, 3 online surveys, and 1 educational evaluation were administered in an attempt to identify facilitators and barriers to bundle adoption. Main Results Factors believed to facilitate bundle implementation included: 1) the performance of daily, interdisciplinary, rounds, 2) engagement of key implementation leaders, 3) sustained and diverse educational efforts, and 4) the bundle's quality and strength. Barriers identified included: 1) intervention related issues (e.g. timing of trials, fear of adverse events), 2) communication and care coordination challenges, 3) knowledge deficits, 4) workload concerns, and 5) documentation burden. Despite these challenges, participants believed implementation ultimately benefited patients, improved interdisciplinary communication, and empowered nurses and other ICU team members. Conclusions In this study of the implementation of the ABCDE bundle in a tertiary care setting, clear factors were identified that both advanced and impeded adoption of this complex intervention that requires interprofessional education, coordination, and cooperation. Focusing on these factors preemptively should enable a more effective and lasting implementation of the bundle and better care for critically ill patients. Lessons learned from this study will also help healthcare providers optimize implementation of the recent ICU Pain, Agitation and Delirium (PAD) Guidelines, which has many similarities but also some important differences as compared to the ABCDE bundle

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Section: Discussionmentioning

confidence: 99%

Implementing the Awakening and Breathing Coordination, Delirium Monitoring/Management, and Early Exercise/Mobility Bundle into Everyday Care

Balas¹,

Burke

Gannon

et al. 2013

Critical Care Medicine

209

183

View full text Add to dashboard Cite

show abstract

“…In contrast, a point prevalence analysis within an international survey showed that 73% of observed patients were not monitored with a validated delirium score [18]. Despite the low implementation rates, delirium monitoring implementation has been shown to be feasible [25,28].…”

Section: Discussionmentioning

confidence: 92%

“…The training method used, included on-the-job-training periods provided by a multi-professional team of nurses and physicians [25].…”

Section: Main Predictor Variablementioning

confidence: 99%

Routine delirium monitoring is independently associated with a reduction of hospital mortality in critically ill surgical patients: A prospective, observational cohort study

Luetz

Weiß

Böettcher

et al. 2016

Journal of Critical Care

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“…In addition, as part of the implementation of the algorithm, the principal investigator and the resource person reminded the nurses to use the algorithm, because feedback strategies were shown to improve adherence in other studies. 20,23,24 Radtke and colleagues 26 found that sustained documentation rates for sedation, pain, and delirium scores increased significantly when they used an expanded training program (i.e., resource group, lectures, movie, handouts, one to one instructions over three cycles) compared to a traditional training program (i.e., over one cycle). In the current study, a traditional training approach was used.…”

Section: Nurses' Adherence With the Algorithmmentioning

confidence: 98%

Implementation of a pain management algorithm in intensive care units and evaluation of nurses' level of adherence with the algorithm

et al. 2015

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How to implement monitoring tools for sedation, pain and delirium in the intensive care unit: an experimental cohort study

Abstract: A modified extended training strategy for ICU monitoring tools (sedation, pain, delirium) leads to higher intermediate and long-term implementation rates and is associated with improved patient outcome. However, these findings may have been biased by unmeasured confounders.

Cited by 62 publications

References 25 publications

Implementing the Awakening and Breathing Coordination, Delirium Monitoring/Management, and Early Exercise/Mobility Bundle into Everyday Care

Implementing the Awakening and Breathing Coordination, Delirium Monitoring/Management, and Early Exercise/Mobility Bundle into Everyday Care

Routine delirium monitoring is independently associated with a reduction of hospital mortality in critically ill surgical patients: A prospective, observational cohort study

Implementation of a pain management algorithm in intensive care units and evaluation of nurses' level of adherence with the algorithm

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