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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.
Background:
The ABCDE bundle is a multifaceted, interprofessional intervention that is associated with reduced ventilator and delirium days as well as increased likelihood of mobility in intensive care.
Objectives:
The aim of this study is to describe organizational domains that contribute to variation in ABCDE bundle implementation as reported by intensive care unit providers and to examine the capability of a conceptual framework for identifying variation in ABCDE bundle implementation.
Methods:
We conducted 2 separate focus groups that included nurses, respiratory therapists, occupational and physical therapists (N = 16) from the surgical and medical intensive care units at 1 academic medical center. All participants had experience performing ABCDE bundle activities.
Results:
Variation in how the ABCDE bundle was interpreted and executed within and across disciplines was noted. Organizational facets, the physical environment, labor quantity and quality, task burden, provider attitudes, and patient characteristics were noted to influence ABCDE bundle execution. The difficulty coordinating and implementing early mobility was emphasized.
Discussion:
The number of disciplines required to perform an activity and individual component complexity was reported to influence ABCDE bundle implementation. Nurses repeatedly described challenges with coordinating care across disciplines. Small tests of change, adequate staffing, interprofessional training and protocol development efforts, and role modeling may be effective methods for successful ABCDE bundle implementation.
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