An Exploration of Critical Care Professionals' Strategies to Enhance Daily Implementation of the Assess, Prevent, and Manage Pain; Both Spontaneous Awakening and Breathing Trials; Choice of Analgesia and Sedation; Delirium Assess, Prevent, and Manage; Early Mobility and Exercise; and Family Engagement and Empowerment: A Group Concept Mapping Study

被引：4

作者：

Mion, Lorraine C. ^{[1
]}

Tan, Alai ^{[1
]}

Brockman, Audrey ^{[1
]}

Tate, Judith A. ^{[1
]}

Vasilevskis, Eduard E. ^{[2
,3
,4
]}

Pun, Brenda T. ^{[2
]}

Rosas, Scott R. ^{[5
]}

Balas, Michele C. ^{[6
]}

机构：

[1] Ohio State Univ, Coll Nursing, Columbus, OH 43210 USA

[2] Vanderbilt Univ, Dept Med Pulm & Crit Care Crit Illness Brain Dysfu, Med Ctr, Nashville, TN USA

[3] Vanderbilt Univ, Hosp Med, Ctr Qual Aging, Dept Med Gen Internal Med & Publ Hlth,Med Ctr, Nashville, TN USA

[4] Geriatr Res Educ & Clin Ctr, Clin Res Training Ctr Excellence, Vet Affairs Tennessee Valley Healthcare Syst, Nashville, TN USA

[5] Concept Syst Inc, Ithaca, NY USA

[6] Univ Nebraska, Coll Nursing, Med Ctr, Omaha, NE USA

来源：

CRITICAL CARE EXPLORATIONS | 2023年 / 5卷 / 03期

基金：

美国国家卫生研究院;

关键词：

intensive care units; observational study; patient care bundles; problem solving; quality improvement; ICU CAPACITY STRAIN; ADULT PATIENTS; QUALITY; PATIENT; BUNDLE; COMMUNICATION; TEAMWORK; SCIENCE; TEAMS; UNIT;

D O I：

10.1097/CCE.0000000000000872

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

OBJECTIVES:The goals of this exploratory study were to engage professionals from the Society for Critical Care Medicine ICU Liberation Collaborative ICUs to: 1) conceptualize strategies to enhance daily implementation of the Assess, prevent, and manage pain; Both spontaneous awakening and breathing trials; Choice of analgesia and sedation; Delirium assess, prevent, and manage; Early mobility and exercise; and Family engagement and empowerment (ABCDEF) bundle from different perspectives and 2) identify strategies to prioritize for implementation.DESIGN:Mixed-methods group concept mapping over 8 months using an online method. Participants provided strategies in response to a prompt about what was needed for successful daily ABCDEF bundle implementation. Responses were summarized into a set of unique statements and then rated on a 5-point scale on degree of necessity (essential) and degree to which currently used.SETTING:Sixty-eight academic, community, and federal ICUs.PARTICIPANTS:A total of 121 ICU professionals consisting of frontline and leadership professionals.INTERVENTIONS:None.MEASUREMENTS AND MAIN RESULTS:A final set of 76 strategies (reduced from 188 responses) were suggested: education (16 strategies), collaboration (15 strategies), processes and protocols (13 strategies), feedback (10 strategies), sedation/pain practices (nine strategies), education (eight strategies), and family (five strategies). Nine strategies were rated as very essential but infrequently used: adequate staffing, adequate mobility equipment, attention to (patient's) sleep, open discussion and collaborative problem solving, nonsedation methods to address ventilator dyssynchrony, specific expectations for night and day shifts, education of whole team on interdependent nature of the bundle, and effective sleep protocol.CONCLUSIONS:In this concept mapping study, ICU professionals provided strategies that spanned a number of conceptual implementation clusters. Results can be used by ICU leaders for implementation planning to address context-specific interdisciplinary approaches to improve ABCDEF bundle implementation.

引用

页数：12