Measuring Performance on the ABCDEF Bundle During Interprofessional Rounds via a Nurse-Based Assessment Tool

Area of Science:

• Critical Care Medicine
• Nursing Research
• Evidence-Based Practice

Background:

• Nurse-led rounding checklists are common in intensive care units (ICUs) to promote evidence-based practice.
• Customizing checklists per patient assumes reliable assessment of discussed items by a single observer.
• The reliability of a single nurse assessing checklist item discussion during rounds is not well-established.

Purpose of the Study:

• To evaluate the reliability of one critical care nurse in assessing checklist items during multidisciplinary ICU rounds.
• To determine if a single rater can accurately gauge the discussion of ABCDEF bundle elements.

Main Methods:

• Two nurses observed 118 multidisciplinary ICU rounds using a standardized paper-based tool.
• Each nurse assessed the discussion of 17 items related to the ABCDEF bundle.
• Generalizability coefficients were calculated to measure single-rater reliability, with >= 0.70 considered sufficient.

Main Results:

• For 11 out of 17 items (65%), the generalizability coefficient for a single rater met or exceeded the 0.70 threshold.
• Reliable assessment (>= 0.70) was achieved for key items including pain (0.86), delirium score (0.74), spontaneous breathing trial (0.80), and family engagement (0.82).
• Some items, like agitation score (0.72), showed variability in reliability.

Conclusions:

• A single trained critical care nurse can reliably assess the discussion of most ABCDEF bundle elements during multidisciplinary rounds.
• This finding supports the practice of using a single nurse to assess and customize rounding checklists in the ICU.
• Reliable single-rater assessment enhances the efficiency of implementing evidence-based practices in critical care settings.