Liberation Playbook: Pain, Sedation, Sleep, and Mobility Led by Advanced Practice Registered Nurses

Area of Science:

• Critical Care Medicine
• Nursing
• Patient Safety

Background:

• Mechanical ventilation, while life-saving, carries risks such as deep sedation and immobility.
• The ABCDEF bundle is designed to mitigate these risks and improve patient recovery.

Purpose of the Study:

• To synthesize evidence supporting the "awake-and-walking" intensive care unit model.
• To define the role of advanced practice registered nurses in implementing this model.
• To provide strategies for overcoming implementation barriers.

Main Methods:

• Evidence synthesis on the ABCDEF bundle and awake-and-walking ICU.
• Defining the advanced practice registered nurse's role in implementation.
• Case example analysis and barrier/solution mapping.

Main Results:

• The ABCDEF bundle improves survival, reduces delirium and coma, and shortens ventilation duration.
• Advanced practice registered nurses are key to embedding bundle elements, coordinating teams, and driving culture change.
• Pragmatic strategies exist to address workflow fragmentation, staffing variability, and safety concerns.

Conclusions:

• The "awake-and-walking" ICU model, facilitated by the ABCDEF bundle, enhances patient recovery.
• Reliable implementation requires interprofessional collaboration, protocol standardization, and data transparency.
• Advanced practice registered nurses play a pivotal role in successful adoption and sustained practice change.