Organizational Domains and Variation in Attitudes of Intensive Care Providers Toward the ABCDE Bundle

Boehm, Leanne M.; Vasilevskis, Eduard E.; Dietrich, Mary S.; Wells, Nancy; Ely, E. Wesley; Pandharipande, Pratik P.; Mion, Lorraine C.

doi:10.4037/ajcc2017297

Cited by 28 publications

(33 citation statements)

References 21 publications

(26 reference statements)

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“…We had found (reported elsewhere) that policy and protocol factors, unit milieu, and access to supplies and equipment are organizational domains most closely associated with difficulty carrying out the bundle. 23 Thus, for example, access to supplies and equipment can be improved by keeping necessary ABCDE bundle supplies (e.g., ambu bag, ventilator extension tubing, gait belt, etc.) and equipment (e.g., walker, high-back chair, oxygen tank, lift, etc.)…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Perceptions of Workload Burden and Adherence to ABCDE Bundle Among Intensive Care Providers

Boehm¹,

Dietrich²,

Vasilevskis³

et al. 2017

Am J Crit Care

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Background The ABCDE interprofessional bundle (Awakening and Breathing Coordination, Delirium monitoring and management, and Early mobility) is recommended practice in intensive care, but adoption is limited. Objective To examine the relationship between ICU provider attitudes regarding the ABCDE bundle and ABCDE bundle adherence. Methods A one-time survey of ICU providers (N=268) was conducted in ten ICUs across the country. ICU providers must have worked ≥4 shifts/month. We examined the following provider attitudes: workload burden, difficulty carrying out the bundle, perceived safety, confidence, and perceived strength of evidence. Logistic regression models were used to examine the relationship of unit level provider attitudes with patient level (N=101) ABCDE bundle adherence, adjusted for patient age, severity of illness, and comorbidity. Results For every unit increase in workload burden, there was a 53% decrease in adherence to the ABCDE bundle (OR=0.47, CI=0.28–0.79, p=0.004). Bundle difficulty (OR=0.29, CI=0.08–1.07), perceived safety (OR=0.51, CI=0.10–2.65), confidence (OR=0.37, CI=0.10–1.35), and perceived strength of evidence (OR=0.69, CI=0.14–3.35) were not associated with ABCDE bundle adherence. For every unit increase in perceived difficulty carrying out the bundle, there was a 59% reduction in adherence with early mobility (OR=0.41, CI=0.19–0.90, p=0.027). Additionally, ABCDE bundle adherence (i.e., ventilator bundle) was less than DE bundle adherence (i.e., ventilator-free bundle) (97% vs. 72%, z=5.47, p<0.001). Conclusions Reported workload burden influences ABCDE bundle adherence. High perceived difficulty carrying out the bundle impacts adherence with early mobility. Focusing interventions on workload burden and factors influencing bundle difficulty may facilitate ABCDE bundle adherence.

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Section: Discussionmentioning

confidence: 99%

“…23 The investigator conducted in-person meetings with the leadership of each unit and department at participating hospitals to describe survey distribution requirements. An electronic survey link was forwarded to the targeted ICU healthcare professionals by unit and departmental leadership.…”

Section: Methodsmentioning

confidence: 99%

Perceptions of Workload Burden and Adherence to ABCDE Bundle Among Intensive Care Providers

Boehm¹,

Dietrich²,

Vasilevskis³

et al. 2017

Am J Crit Care

Self Cite

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“…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%

“…The second study was a survey by Boehm et al [39 ▪▪ ] of clinicians focusing on the relationship between provider attitudes toward the ABCDE bundle and organizational domains. Three hundred fifteen surveys were included (response rate of 25%).…”

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

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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.

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“…RTs also facilitate communication between physicians, nurses, physical therapists, and other members of the care team. Additionally, utiliz-ing a multi-layered process of care can have barriers to implementation, [98][99][100] so understanding the individual elements, the impact that the ABCDEF bundle has in the care of critically ill patients, and the unique culture and organization of ICUs puts RTs in an instrumental position to implement best practices and provide insight into the necessary requirements for building the bundle in their own institutions.…”

Section: The Abcdef Bundle: Synergistic Care Improving Outcomesmentioning

confidence: 99%

The ABCDEF Bundle for the Respiratory Therapist

2019

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The clinical approach to the critically ill patient has changed dramatically over the last several decades from one of deep sedation to that of mobilizing patients on mechanical ventilation and limiting sedation. The ABCDEF bundle is a multidisciplinary, evidence-based approach to the holistic management of critically ill patients that aims to optimize patient recovery, minimize iatrogenesis, and engage and empower the patient and family during their hospitalization. To achieve this goal, the bundle includes assessments for pain, delirium, and readiness to stop sedation and to start spontaneous breathing trials. It also encourages early mobilization of the patient, avoidance of restraints, and engagement with the family in bedside rounds to improve communication. Performance of this bundle reduces mortality, ventilator days, intensive care readmissions, delirium, coma, restraint use, and discharge to facilities in a dose-dependent manner. The respiratory therapist, as a key member of the critical care team, is essential to the implementation, performance, and success of the ABCDEF bundle. This review aims to describe each component of the ABCDEF bundle, provide evidence for both the impact of individual interventions as well as the entire bundle, and detail the importance of this multidisciplinary approach to the care of the critically ill patient.

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Organizational Domains and Variation in Attitudes of Intensive Care Providers Toward the ABCDE Bundle

Cited by 28 publications

References 21 publications

Perceptions of Workload Burden and Adherence to ABCDE Bundle Among Intensive Care Providers

Perceptions of Workload Burden and Adherence to ABCDE Bundle Among Intensive Care Providers

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

The ABCDEF Bundle for the Respiratory Therapist

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