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Interprofessional Perspectives on ABCDE Bundle Implementation: A Focus Group Study.

Leanne M Boehm1, Eduard E Vasilevskis, Lorraine C Mion

  • 1Leanne M. Boehm, PhD, RN, ACNS-BC, is from the Vanderbilt University School of Nursing; Tennessee Valley Healthcare System, Geriatric Research Education and Clinical Center, Veterans Affairs Quality Scholars Program; and Vanderbilt University, Division of Allergy, Pulmonary and Critical Care Medicine, Institute for Medicine and Public Health, Center for Health Services Research, in Nashville, Tennessee. She is a postdoctoral nurse fellow with the Veterans Affairs Quality Scholars program at the Tennessee Valley Healthcare System and the Vanderbilt University School of Nursing. Dr Boehm's research interests include implementation science and organizational factors influencing interprofessional protocol implementation in acute care. Eduard E. Vasilevskis, MD, MPH, is from the Vanderbilt University, Division of General Internal Medicine and Public Health, Section of Hospital Medicine, Center for Health Services Research, in Nashville, Tennessee. He is an assistant professor at the Vanderbilt University Medical Center and the Tennessee Valley VA Geriatric Research Education and Clinical Care Center. Dr Vasilevskis' research is focused on the development of quality of care measures and improvement strategies for reducing hospital-acquired delirium and long-term cognitive dysfunction among hospitalized patients. Lorraine C. Mion, PhD, RN, FAAN, is from the Vanderbilt University School of Nursing and Tennessee Valley Healthcare System, Geriatric Research Education and Clinical Center, Veterans Affairs Quality Scholars Program, in Nashville, Tennessee. She is currently a research professor at the College of Nursing, Ohio State University, and nurse scientist at the Ohio State University Wexner Medical Center, Columbus Ohio. Dr Mion's research interests are in the area of acute care geriatrics, quality, and safety.

Dimensions of Critical Care Nursing : DCCN
|October 18, 2016
PubMed
Summary
This summary is machine-generated.

Implementing the ABCDE bundle in intensive care units varies due to organizational factors and provider challenges. Addressing staffing, training, and coordination can improve its execution for better patient outcomes.

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Area of Science:

  • Critical Care Medicine
  • Healthcare Management
  • Interprofessional Collaboration

Background:

  • The ABCDE bundle is a key intervention in intensive care units (ICUs).
  • It aims to reduce mechanical ventilation and delirium duration, and enhance patient mobility.
  • Understanding implementation variations is crucial for optimizing its effectiveness.

Purpose of the Study:

  • To identify organizational factors influencing the implementation of the ABCDE bundle.
  • To explore how intensive care unit (ICU) providers perceive variations in bundle execution.
  • To assess a conceptual framework for analyzing these implementation variations.

Main Methods:

  • Conducted two focus groups with 16 participants (nurses, respiratory therapists, occupational therapists, physical therapists).
  • Participants were from surgical and medical ICUs at an academic medical center.
  • All participants had experience with ABCDE bundle activities.

Main Results:

  • Significant variation in ABCDE bundle interpretation and execution across disciplines and within units was observed.
  • Organizational aspects, including physical environment, staffing (quantity/quality), workload, provider attitudes, and patient factors, impact execution.
  • Coordinating and implementing early mobility presented notable challenges.

Conclusions:

  • The complexity of individual components and the number of disciplines involved affect ABCDE bundle implementation.
  • Nurses frequently reported difficulties in coordinating interprofessional care.
  • Strategies like small tests of change, adequate staffing, interprofessional training, protocol development, and role modeling can enhance successful implementation.