Identifying Barriers to Delivering the Awakening and Breathing Coordination, Delirium, and Early Exercise/Mobility Bundle to Minimize Adverse Outcomes for Mechanically Ventilated Patients

Costa, Deena Kelly; White, Matthew; Ginier, Emily; Manojlovich, Milisa; Govindan, Sushant; Iwashyna, Theodore J.; Sales, Anne E.

doi:10.1016/j.chest.2017.03.054

Cited by 130 publications

(121 citation statements)

References 68 publications

Supporting

Mentioning

108

Contrasting

Unclassified

Order By: Relevance

“…Although it may be difficult to observe similarities in barriers when comparing individual studies, the use of a conceptual framework such as CFIR allows implementation researchers to classify barriers into major domains and themes. As Table 1 [10 ▪▪ ,38 ▪▪ ,39 ▪▪ ,40–42 ▪ ,48 ▪▪ ,49 ▪▪ ,53 ▪▪ ]demonstrates, the recent literature has identified a multitude of barriers that fall within all five CFIR domains, although most studies have investigated barriers in the inner setting and individuals domains. Having a systematically derived catalog of barriers allows implementation researchers and clinicians to design and evaluate implementation strategies that are targeted correctly, allowing for the greatest chance of success in improving the adoption of evidence-based practice.…”

Section: Resultsmentioning

confidence: 99%

“…Several recent studies have examined the facilitators and barriers to ABCDE implementation or implementation of individual ABCDE components. Costa et al [38 ▪▪ ] conducted a systematic review to identify barriers to ABCDE implementation (both the full bundle and individual components) and classify them according to CFIR domains. They identified 107 barriers from 49 studies.…”

Section: Bundled Management Of Mechanically Ventilated Patientsmentioning

confidence: 99%

See 1 more Smart Citation

Why do we fail to deliver evidence-based practice in critical care medicine?

Weiss

2017

Current Opinion in Critical Care

View full text Add to dashboard Cite

Purpose of review The use of evidence-based practices in clinical practice is frequently inadequate. Recent research has uncovered many barriers to the implementation of evidence-based practices in critical care medicine. Using a comprehensive conceptual framework, this review identifies and classifies the barriers to implementation of several major critical care evidence-based practices. Recent findings The many barriers that have been recently identified can be classified into domains of the consolidated framework for implementation research (CFIR). Barriers to the management of patients with acute respiratory distress syndrome (ARDS) include ARDS under-recognition. Barriers to the use of the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility (ABCDE) bundle for mechanically ventilated patients and the sepsis bundle include patient-related, clinician-related, protocol-related, contextual-related, and intervention-related factors. Although these many barriers can be classified into all five CFIR domains (intervention, outer setting, inner setting, individuals, and process), most barriers fall within the individuals and inner setting domains. Summary There are many barriers to the implementation of evidence-based practice in critical care medicine. Systematically classifying these barriers allows implementation researchers and clinicians to design targeted implementation strategies, giving them the greatest chance of success in improving the use of evidence-based practice.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Bundled Management Of Mechanically Ventilated Patientsmentioning

confidence: 99%

Why do we fail to deliver evidence-based practice in critical care medicine?

Weiss

2017

Current Opinion in Critical Care

View full text Add to dashboard Cite

show abstract

“…Some are related to the patient, including safety concerns in terms of hemodynamical instability or lack of cooperation. 169 The majority are related to the clinician implementing the bundle, in particular lack of knowledge about its benefits, reluctance to follow guidelines, preference for autonomy, perceived increased workload, 170 and lack of confidence in the bundle's efficacy. [169][170][171] Finally, there are barriers related to the structure of the ICU, including culture and organization, teamwork, physical environment, lack of resources, and inadequate management/leadership.…”

Section: Implementation Challenges and Difficultiesmentioning

confidence: 99%

Prevention and Management of Delirium in the Intensive Care Unit

Mart

Roberson

Salas

et al. 2020

Semin Respir Crit Care Med

View full text Add to dashboard Cite

Delirium is a debilitating form of brain dysfunction frequently encountered in the intensive care unit (ICU). It is associated with increased morbidity and mortality, longer lengths of stay, higher hospital costs, and cognitive impairment that persists long after hospital discharge. Predisposing factors include smoking, hypertension, cardiac disease, sepsis, and premorbid dementia. Precipitating factors include respiratory failure and shock, metabolic disturbances, prolonged mechanical ventilation, pain, immobility, and sedatives and adverse environmental conditions impairing vision, hearing, and sleep. Historically, antipsychotic medications were the mainstay of delirium treatment in the critically ill. Based on more recent literature, the current Society of Critical Care Medicine (SCCM) guidelines suggest against routine use of antipsychotics for delirium in critically ill adults. Other pharmacologic interventions (e.g., dexmedetomidine) are under investigation and their impact is not yet clear. Nonpharmacologic interventions thus remain the cornerstone of delirium management. This approach is summarized in the ABCDEF bundle (Assess, prevent, and manage pain; Both SAT and SBT; Choice of analgesia and sedation; Delirium: assess, prevent, and manage; Early mobility and exercise; Family engagement and empowerment). The implementation of this bundle reduces the odds of developing delirium and the chances of needing mechanical ventilation, yet there are challenges to its implementation. There is an urgent need for ongoing studies to more effectively mitigate risk factors and to better understand the pathobiology underlying ICU delirium so as to identify additional potential treatments. Further refinements of therapeutic options, from drugs to rehabilitation, are current areas ripe for study to improve the short- and long-term outcomes of critically ill patients with delirium.

show abstract

“…Optimizing critical care in intensive care units (ICU) based on evidence‐based practice (EBP), international consensus, and guidelines outlined from all available scientific knowledge is important to enhance patient outcomes . The implementation of EBP remains a challenge and lack of effective communication is one among many other implementation barriers in the ICU . Gathering multi‐professional teams for teaching and training purposes is particularly demanding due to the busy ICU environment and the context in which critical care is provided .…”

Section: Introductionmentioning

confidence: 99%

“…The implementation of EBP remains a challenge and lack of effective communication is one among many other implementation barriers in the ICU . Gathering multi‐professional teams for teaching and training purposes is particularly demanding due to the busy ICU environment and the context in which critical care is provided . Moreover, traditional electronical professional hospital communication platforms generally require a login procedure onto a hospital server, limiting the accessibility and thus effective real time communication about EBP.…”

Section: Introductionmentioning

confidence: 99%

Use of social media for communicating about critical care topics: A Norwegian cross‐sectional survey

Petosic

Sunde

Beeckman

et al. 2019

Acta Anaesthesiol Scand

View full text Add to dashboard Cite

Funding informationDepartmental funding only.Background: Social media (SoMe) might be an alternative platform for communicating critical care topics to implement evidence-based practice in the intensive care unit (ICU). This survey aims to describe ICU nurses' and physicians' use of SoMe in general, and their perception of using closed Facebook-groups for receiving content on critical care topics. Methods:A cross-sectional, web-based, anonymous survey was distributed to ICU physicians and nurses in four ICUs in autumn 2017 via an email-campaign. Descriptive statistics with rates, percentages and median numeric rating scale (NRS) scores, interquartile ranges are presented. Results:The response-rate was 64% (253/ 394) including 210 nurses and 43 physicians. Overall, 93% had a SoMe-profile, and 77% had a profile on more than one network site. Facebook was the most used social network site, with 87% having a profile. Totally, 68% were daily users, but more nurses used Facebook daily vs physicians (81% vs 60%, respectively, P = 0.006). Nurses were also more positive toward being members of closed Facebook-groups aimed to exchange content on critical care topics (median NRS 9 (6-10) vs 6 (3-9), respectively, P = 0.014). Conclusion:The majority of ICU nurses and physicians were active SoMe users, mainly for personal purposes, and Facebook was the most popular SoMe. Nurses used Facebook daily more frequent and were more positive toward content on critical care topics on Facebook than physicians. These findings might be relevant to customize future communication about critical care topics via SoMe.This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

show abstract

Identifying Barriers to Delivering the Awakening and Breathing Coordination, Delirium, and Early Exercise/Mobility Bundle to Minimize Adverse Outcomes for Mechanically Ventilated Patients

Cited by 130 publications

References 68 publications

Why do we fail to deliver evidence-based practice in critical care medicine?

Why do we fail to deliver evidence-based practice in critical care medicine?

Prevention and Management of Delirium in the Intensive Care Unit

Use of social media for communicating about critical care topics: A Norwegian cross‐sectional survey

Contact Info

Product

Resources

About