Common Challenges to Effective ABCDEF Bundle Implementation: The ICU Liberation Campaign Experience

被引：51

作者：

Balas, Michele C. ^{[1
,2
]}

Pun, Brenda T. ^{[3
]}

Pasero, Chris

Engel, Heidi J. ^{[4
]}

Perme, Christiane ^{[5
]}

Esbrook, Cheryl L. ^{[6
]}

Kelly, Tamra ^{[7
]}

Hargett, Ken D. ^{[5
]}

Posa, Patricia J. ^{[8
]}

Barr, Juliana ^{[9
,10
]}

Devlin, John W. ^{[11
,12
]}

Morse, Alexandra ^{[7
]}

Barnes-Daly, Mary Ann ^{[7
]}

Puntillo, Kathleen A. ^{[13
]}

Aldrich, J. Matthew ^{[14
,15
]}

Schweickert, William D. ^{[16
]}

Harmon, Lori ^{[17
]}

Byrum, Diane G. ^{[18
]}

Carson, Shannon S. ^{[19
]}

Ely, E. Wesley ^{[20
,21
]}

Stollings, Joanna L. ^{[22
]}

机构：

[1] Ohio State Univ, Coll Nursing, Ctr Excellence Crit & Complex Care, Columbus, OH 43210 USA

[2] Ohio State Univ, Wexner Med Ctr, Columbus, OH 43210 USA

[3] Vanderbilt Univ, Med Ctr, Nashville, TN USA

[4] Univ Calif San Francisco, Dept Rehabil Serv, San Francisco, CA 94143 USA

[5] Houston Methodist Hosp, Houston, TX USA

[6] Univ Chicago Med, Chicago, IL USA

[7] Sutter Hlth, Sacramento, CA USA

[8] St Joseph Mercy Hlth Syst, Ann Arbor, MI USA

[9] VA Palo Alto Hlth Care Syst, Palo Alto, CA USA

[10] Stanford Univ, Sch Med, Dept Anesthesiol Perioperat & Pain Med, Stanford, CA 94305 USA

[11] Northeastern Univ, Pharm, Boston, MA 02115 USA

[12] Tufts Med Ctr, Div Pulm Crit Care & Sleep Med, Boston, MA 02111 USA

[13] Univ Calif San Francisco, Sch Nursing, Dept Physiol Nursing, San Francisco, CA 94143 USA

[14] Univ Calif San Francisco, Med Ctr, Crit Care Med, San Francisco, CA USA

[15] Univ Calif San Francisco, Med Ctr, San Francisco, CA USA

[16] Univ Penn, Perelman Sch Med, Med Clin, Philadelphia, PA 19104 USA

[17] Soc Crit Care Med, Qual, Mt Prospect, IL USA

[18] Innovat Solut Healthcare Educ LLC, Charlotte, NC USA

[19] Univ N Carolina, Sch Med, Chapel Hill, NC 27515 USA

[20] Vanderbilt Univ, Sch Med, Med, Nashville, TN 37212 USA

[21] VA Tennessee Valley Geriatr Res Educ Clin Ctr, Nashville, TN USA

[22] Vanderbilt Univ, Med Ctr, Dept Pharm Serv, Nashville, TN USA

来源：

CRITICAL CARE NURSE | 2019年 / 39卷 / 01期

基金：

美国国家卫生研究院;

关键词：

INTENSIVE-CARE-UNIT; CRITICALLY-ILL PATIENTS; MECHANICALLY VENTILATED PATIENTS; CONFUSION ASSESSMENT METHOD; ACUTE RESPIRATORY-FAILURE; QUALITY IMPROVEMENT; PAIN MANAGEMENT; DELIRIUM MONITORING/MANAGEMENT; PERFORMANCE IMPROVEMENT; BREATHING COORDINATION;

D O I：

10.4037/ccn2019927

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Although growing evidence supports the safety and effectiveness of the ABCDEF bundle (A, assess, prevent, and manage pain; B, both spontaneous awakening and spontaneous breathing trials; C, choice of analgesic and sedation; D, delirium: assess, prevent, and manage; E, early mobility and exercise; and F, family engagement and empowerment), intensive care unit providers often struggle with how to reliably and consistently incorporate this interprofessional, evidence-based intervention into everyday clinical practice. Recently, the Society of Critical Care Medicine completed the ICU Liberation ABCDEF Bundle Improvement Collaborative, a 20-month, nationwide, multicenter quality improvement initiative that formalized dissemination and implementation strategies and tracked key performance metrics to overcome barriers to ABCDEF bundle adoption. The purpose of this article is to discuss some of the most challenging implementation issues that Collaborative teams experienced, and to provide some practical advice from leading experts on ways to overcome these barriers.

引用

页码：46 / 60

页数：15

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