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Perceptions of Workload Burden and Adherence to ABCDE Bundle Among Intensive Care Providers
Leanne M Boehm1, Mary S Dietrich2, Eduard E Vasilevskis2
1Leanne M. Boehm is a postdoctoral fellow, Vanderbilt University School of Nursing, a quality scholar, VA Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), and a research nurse, Department of Medicine, Center for Health Services Research, Vanderbilt University, Nashville, Tennessee. Mary S. Dietrich is a professor of biostatistics, School of Nursing and School of Medicine, Vanderbilt University. Eduard E. Vasilevskis is a staff physician, VA Tennessee Valley Healthcare System, GRECC and an assistant professor of medicine, Center for Health Services Research, Vanderbilt University. Nancy Wells is a research professor, Vanderbilt University School of Nursing and Vanderbilt University Medical Center, Nashville, Tennessee. Pratik Pandharipande is a professor of anesthesiology and surgery, Vanderbilt University School of Medicine and a staff physician, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System. E. Wesley Ely is associate director, VA Tennessee Valley Healthcare System, GRECC, and a professor, Department of Medicine and Center for Health Services Research, Vanderbilt University. Lorraine C. Mion is a research professor and interim director of the Center of Excellence in Critical and Complex Care, The Ohio State University School of Nursing, Columbus, Ohio. leanne.boehm@vanderbilt.edu.
Background:
Use of the interprofessional Awakening and Breathing Coordination, Delirium Monitoring and Management, and Early Mobility (ABCDE) bundle is recommended practice in intensive care, but its adoption remains limited.
Objective:
To examine the relationship between intensive care unit provider attitudes regarding the ABCDE bundle and ABCDE bundle adherence.
Methods:
A 1-time survey of 268 care providers in 10 intensive care units across the country who had worked at least 4 shifts per month to examine their attitudes toward workload burden, difficulty carrying out the bundle, perceived safety, confidence, and perceived strength of evidence. Logistic regression models were used to examine the relationship of unit-level provider attitudes with ABCDE bundle adherence in 101 patients, adjusted for patients' age, severity of illness, and comorbidity.
Results:
For every unit increase in workload burden, adherence to the ABCDE bundle decreased 53% (odds ratio [OR], 0.47; 95% CI, 0.28-0.79; P = .004). Bundle difficulty (OR, 0.29; 95% CI, 0.08-1.07), perceived safety (OR, 0.51; 95% CI, 0.10-2.65), confidence (OR, 0.37, 95% CI, 0.10-1.35), and perceived strength of evidence (OR, 0.69; 95% CI, 0.14-3.35) were not associated with ABCDE bundle adherence. For every unit increase in perceived difficulty carrying out the bundle, adherence with early mobility was reduced 59% (OR, 0.41; 95% CI, 0.19-0.90; P = .03). In addition, ABCDE bundle adherence (ie, ventilator bundle) was less than DE bundle adherence (ie, ventilator-free bundle) (97% vs 72%, z = 5.47; P < .001).
Conclusions:
Focusing interventions on workload burden and factors influencing bundle difficulty may facilitate ABCDE bundle adherence.
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