Improving Health Care for Critically Ill Patients Using an Evidence-Based Collaborative Approach to ABCDEF Bundle Dissemination and Implementation

Mary Ann Barnes-Daly; Brenda T Pun; Lori A Harmon; Diane G Byrum; Vishakha K Kumar; John W Devlin; Joanna L Stollings; Kathleen A Puntillo; Heidi J Engel; Patricia J Posa; Juliana Barr; William D Schweickert; Cheryl L Esbrook; Ken D Hargett; Shannon S Carson; J Matthew Aldrich; E Wesley Ely; Michele C Balas

doi:10.1111/wvn.12290

Improving Health Care for Critically Ill Patients Using an Evidence-Based Collaborative Approach to ABCDEF Bundle Dissemination and Implementation

Worldviews Evid Based Nurs. 2018 Jun;15(3):206-216. doi: 10.1111/wvn.12290. Epub 2018 May 5.

Authors

Mary Ann Barnes-Daly¹, Brenda T Pun², Lori A Harmon³, Diane G Byrum⁴, Vishakha K Kumar⁵, John W Devlin⁶, Joanna L Stollings⁷, Kathleen A Puntillo⁸, Heidi J Engel⁹, Patricia J Posa¹⁰, Juliana Barr^{11

12}, William D Schweickert¹³, Cheryl L Esbrook¹⁴, Ken D Hargett¹⁵, Shannon S Carson¹⁶, J Matthew Aldrich¹⁷, E Wesley Ely¹⁸, Michele C Balas¹⁹

Affiliations

¹ Clinical Performance Improvement Consultant, Sutter Health, Sacramento, CA, USA.
² Clinical Program Manager, Vanderbilt University Medical Center, Nashville, TN, USA.
³ Director Quality, Society of Critical Care Medicine, Mount Prospect, IL, USA.
⁴ Quality Implementation Consultant, Innovative Solutions for HealthCare Education LLC, Chicago, IL, USA.
⁵ Senior Manager, Research, Society of Critical Care Medicine, Mount Prospect, IL, USA.
⁶ Professor of Pharmacy, School of Pharmacy, Northeastern University, and Scientific Staff, Division of Pulmonary and Critical Care Medicine, Tufts Medical Center, Boston, MA, USA.
⁷ Medical Intensive Care Unit Clinical Pharmacy Specialist and Pharmacist ICU Recovery Center, Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN, USA.
⁸ Professor Emerita, School of Nursing, University of California, San Francisco, San Francisco, CA, USA.
⁹ Clinical Specialist, Department of Rehabilitative Services, University of California, San Francisco, CA, USA.
¹⁰ Quality Excellence Leader, Saint Joseph Mercy Health System, Ann Arbor, MI, USA.
¹¹ Associate Professor, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.
¹² Staff Anesthesiologist and Intensivist at the VA, Anesthesiology Service, VA Palo Alto Health Care System, Palo Alto, CA, USA.
¹³ Director, Medical Critical Care Operations, Division of Pulmonary, Allergy and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
¹⁴ Program Coordinator of Occupational Therapy Professional Development, University of Chicago Medicine, Chicago, IL, USA.
¹⁵ Director, Respiratory Care Services, Houston Methodist Hospital, Houston, TX, USA.
¹⁶ Professor of Medicine and Division Chief, Pulmonary Diseases & Critical Care Medicine, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.
¹⁷ Medical Director, Critical Care Medicine, Associate Clinical Professor, Anesthesia and Perioperative Care, University of San Francisco-California Medical Center, San Francisco, CA, USA.
¹⁸ Professor of Medicine, Department of Medicine, Pulmonary and Critical Care and Health Services Research Center, Vanderbilt University School of Medicine and The Tennessee Valley Veteran's Affairs Geriatric Research Education Clinical Center (GRECC), Nashville, TN, USA.
¹⁹ Associate Professor, College of Nursing, Center of Excellence in Critical and Complex Care, The Ohio State University and Nurse Scientist, The Ohio State University Wexner Medical Center, Columbus, OH, USA.

PMID: 29729659
DOI: 10.1111/wvn.12290

Abstract

Background: Patients admitted to intensive care units (ICUs) often experience pain, oversedation, prolonged mechanical ventilation, delirium, and weakness. These conditions are important in that they often lead to protracted physical, neurocognitive, and mental health sequelae now termed postintensive care syndrome. Changing current ICU practice will not only require the adoption of evidence-based interventions but the development of effective and reliable teams to support these new practices.

Objectives: To build on the success of bundled care and bridge an ongoing evidence-practice gap, the Society of Critical Care Medicine (SCCM) recently launched the ICU Liberation ABCDEF Bundle Improvement Collaborative. The Collaborative aimed to foster the bedside application of the SCCM's Pain, Agitation, and Delirium Guidelines via the ABCDEF bundle. The purpose of this paper is to describe the history of the Collaborative, the evidence-based implementation strategies used to foster change and teamwork, and the performance and outcome metrics used to monitor progress.

Methods: Collaborative participants were required to attend four in-person meetings, monthly colearning calls, database training sessions, an e-Community listserv, and select in-person site visits. Teams submitted patient-level data and completed pre- and postimplementation questionnaires focused on the assessment of teamwork and collaboration, work environment, and overall ICU care. Faculty shared the evidence used to derive each bundle element as well as team-based implementation strategies for improvement and sustainment.

Results: Retention in the Collaborative was high, with 67 of 69 adult and eight of nine pediatric ICUs fully completing the program. Baseline and prospective data were collected on over 17,000 critically ill patients. A variety of evidence-based professional behavioral change interventions and novel implementation techniques were utilized and shared among Collaborative members.

Linking evidence to action: Hospitals and health systems can use the Collaborative structure, strategies, and tools described in this paper to help successfully implement the ABCDEF bundle in their ICUs.

Keywords: ABCDEF bundle; collaborative; delirium; evidenced-based practice; guidelines; intensive care.

MeSH terms

Cooperative Behavior*
Critical Illness / rehabilitation
Critical Illness / therapy*
Evidence-Based Practice / methods
Evidence-Based Practice / standards
Humans
Intensive Care Units / organization & administration
Intensive Care Units / standards
Intensive Care Units / statistics & numerical data
Patient Care Bundles / methods
Patient Care Bundles / standards*
Prospective Studies
Quality Improvement*
Surveys and Questionnaires