Reigniting Intensive Care Unit Liberation.

IF 2 4区 医学 Q3 CRITICAL CARE MEDICINE Critical care nurse Pub Date : 2024-08-01 DOI:10.4037/ccn2024629
Margaret Guest, Kevin Craven, Alaina M Tellson, Marlene Porter, Nakeitha James, Lisa Turley, Jeremy Smitherman
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Abstract

Background: The Society of Critical Care Medicine has established guidelines to manage pain, sedation, delirium, immobility, family participation, and sleep disruption in the intensive care unit, a set of interventions known as the intensive care unit liberation (ABCDEF) bundle. Adherence to these guidelines has shown positive results.

Local problem: In the intensive care units of a level I trauma academic teaching hospital in central Texas, the rate of bedside nursing staff adherence to the ABCDEF bundle was only 67.1% in January 2022. The aim of this quality improvement project was to improve adherence to the bundle.

Methods: Knowledge gaps were found to be the driver of the low adherence rate. Two primary needs were identified: (1) education on the elements of the ABCDEF bundle and (2) increased awareness and recognition of incomplete and incorrect documentation. Interventions included focused education on intensive care unit liberation.

Results: From February to June 2022, overall adherence to the ABCDEF bundle increased from 67.1% to 95.3%, ventilator use decreased by approximately 10%, and restraint use dropped by about 9%. The incidence of delirium increased, but this increase was due to incorrect patient assessment before the interventions.

Conclusion: The results of this project are consistent with literature demonstrating that a multifaceted approach to improving ABCDEF bundle adherence can produce sustainable improvement in patient outcomes. This report may help other organizations facing similar challenges improve adherence to the bundle in a postpandemic environment.

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重燃重症监护室解放之火。
背景:重症监护医学会制定了在重症监护病房管理疼痛、镇静、谵妄、不活动、家属参与和睡眠障碍的指南,这套干预措施被称为重症监护病房解放(ABCDEF)束。当地的问题:2022 年 1 月,在德克萨斯州中部一家一级创伤学术教学医院的重症监护病房中,床旁护理人员对 ABCDEF 束的遵守率仅为 67.1%。该质量改进项目旨在提高护理人员对捆绑式护理的依从性:方法:研究发现,知识差距是导致护理人员遵守率低的原因。确定了两个主要需求:(1) 关于 ABCDEF 套件要素的教育;(2) 提高对不完整和不正确文档的认识和识别。干预措施包括对重症监护室解放的重点教育:从 2022 年 2 月到 6 月,ABCDEF 套件的总体遵守率从 67.1% 提高到 95.3%,呼吸机使用率下降了约 10%,束缚措施使用率下降了约 9%。谵妄的发生率有所增加,但增加的原因是干预前对患者的评估不正确:本项目的结果与文献一致,表明采用多方面的方法提高 ABCDEF 套件的依从性可持续改善患者的治疗效果。本报告可帮助面临类似挑战的其他机构在疫后环境中提高对捆绑治疗的依从性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Critical care nurse
Critical care nurse 医学-护理
CiteScore
2.80
自引率
0.00%
发文量
68
审稿时长
>12 weeks
期刊介绍: Critical Care Nurse (CCN) is an official publication of the American Association of Critical-Care Nurses (AACN). Authors are invited to submit manuscripts for consideration and peer review. Clinical topics must meet the mission of CCN and address nursing practice of acute and critically ill patients.
期刊最新文献
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