A multisite study of nurse-reported perceptions and practice of ABCDEF bundle components.

Area of Science:

• Critical Care Medicine
• Nursing Practice
• Patient Safety

Background:

• The ABCDEF bundle is associated with improved patient outcomes in the Intensive Care Unit (ICU).
• Understanding the relationship between nurse attitudes and adherence to the ABCDEF bundle is crucial for effective implementation.
• Previous research highlights the importance of the ICU environment in facilitating evidence-based practices.

Purpose of the Study:

• To compare nurse attitudes regarding the ABCDEF bundle with their self-reported adherence to its components.
• To identify factors influencing the successful implementation of the ABCDEF bundle in ICUs.

Main Methods:

• A cross-sectional study was conducted involving 1661 nurses across 28 ICUs in 18 US hospitals.
• A 53-item survey assessed nurse attitudes and self-reported practice of ABCDEF bundle components.
• Data were collected between November 2011 and August 2015.

Main Results:

• No significant correlations were found between nurse attitudes and adherence to Awakening and Breathing trials or sedation protocols.
• Delirium management discussions during rounds were more likely when facilitated by physicians and nurse managers.
• Early mobilization was more likely when ICU physicians, nurse managers, and the environment supported mobility (r=0.36-0.47).
• Physician leadership strongly correlated with a supportive ICU environment for ABCDEF bundle implementation (r=0.63-0.74).

Conclusions:

• Nurse attitudes alone do not predict adherence to the ABCDEF bundle.
• Effective implementation of the ABCDEF bundle relies heavily on supportive ICU environments.
• Physician and nurse manager leadership are critical in creating such environments and driving adherence.