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Structured Nurse-Led PICU Liberation Bundle (ABCDEF) Discussion During Rounds: A Single-Center, Secondary Analysis of
Oluwatomini A Fashina1, Robert J Kahoud2, Gina M Rohlik3
1Department of Pediatrics, Mayo Clinic Children's, Rochester, MN.
Objective:
The Society of Critical Care Medicine PICU Liberation ABCDEF (A-F) Campaign Collaborative aimed to implement best practices for analgesia (A), breathing (B), comfort/consciousness (C), delirium (D), early mobilization (E), and family engagement and empowerment (F). Our post hoc study of Mayo Clinic data sought to compare the pre-implementation rounding process, which used a nursing script organized by organ systems, with a novel, liberation-focused rounding process emphasizing A-F bundle elements.
Design:
Secondary analysis of pre- vs. post-implementation surveys collected by independent observers during rounds.
Setting:
Medical/surgical PICU in a quaternary-care, academic medical center during April to July 2017.
Subjects:
The observed participants included PICU physicians, nurses, respiratory therapists, pharmacists, and dietitians.
Interventions:
None.
Measurements And Main Results:
Survey responses from 145 team members pre-implementation and 67 post-implementation showed improved team satisfaction, communication, and understanding of daily plans (all p < 0.05). Respondents reported an increased frequency of discussions on bundle components A-E (all p < 0.01). Observations of 41 pre-implementation and 46 post-implementation rounds showed an increase in the frequency of discussion of all components of the bundle (all p < 0.01). However, this finding was not at the expense of increased duration of individual rounds since we failed to find a difference in pre- vs. post-implementation duration per patient (480 vs. 544 s per patient, p = 0.20).
Conclusions:
In 2017, around the time of introducing the nurse-led PICU Liberation rounding process to our practice, we found that after implementation, there was an associated increase in discussions about bundle elements and improved communications and satisfaction in team members.
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