Improving Hospital Survival and Reducing Brain Dysfunction at Seven California Community Hospitals: Implementing PAD Guidelines Via the ABCDEF Bundle in 6,064 Patients*

Barnes‐Daly, Mary Ann; Phillips, Gary; Ely, E. Wesley

doi:10.1097/ccm.0000000000002149

Cited by 338 publications

(217 citation statements)

References 37 publications

Supporting

Mentioning

185

Contrasting

Unclassified

Order By: Relevance

“…The studies on the ABCDE care bundle were followed by initiatives facilitating the introduction of changes and by the concept of ICU liberation promoted by the Society of Critical Care Medicine; moreover, the bundle was widened with an additional element, i.e. family engagement and empowerment (F) [45,47]. The details are presented in Table 3.…”

Section: Choice Of Sedation and Development Of Deliriummentioning

confidence: 99%

ICU delirium ― a diagnostic and therapeutic challenge in the intensive care unit

Kotfis

Marra

Ely

2018

Anaesthesiol Intensive Ther

146

View full text Add to dashboard Cite

ICU delirium is a common medical problem occurring in patients admitted to the intensive care units (ICUs). Studies have shown that ICU delirium is associated with increased mortality, prolonged hospitalization, prolonged mechanical ventilation, costs and the occurrence of cognitive disoders after discharge from ICU. The tools available for ICU delirium screening and diagnosis are validated tests available for all members if the medical team (physicians, nurses, physiotherapists). Their use for routine patient assessment is recommended by international medical and scientific societies. They have been implemented as Pain, Agitation, Delirium (PAD) Guidelines by the Society of Critical Care Medicine. Apart from monitoring, a strategy of prevention and treatment is recommended, based on non-pharmacological approach (restoration of senses, early mobilization, physiotherapy, improvement in sleep hygiene and family involvement) as well as pharmacological treatment (typical and atypical antipsychotics and dexmedetomidine). In this article, we present the risk factors of ICU delirium, available tools for monitoring, as well as options for prevention and treatment of delirium that can be used to improve care over critically ill patients.

show abstract

Section: Choice Of Sedation and Development Of Deliriummentioning

confidence: 99%

ICU delirium ― a diagnostic and therapeutic challenge in the intensive care unit

Kotfis

Marra

Ely

2018

Anaesthesiol Intensive Ther

146

View full text Add to dashboard Cite

show abstract

“…To aid adoption of the SCCM’s Pain, Agitation, Delirium (PAD) guidelines, an evidence-based multicomponent and interprofessional team management strategy, known as ABCDEF bundle (Assess, prevent, and manage pain; Both Spontaneous Awakening Trials (SATs) and Spontaneous Breathing Trials (SBTs); attention to the Choice of analgesia and sedation; Delirium monitoring and management; Early mobility and exercise; and Family engagement and empowerment) has been developed and implemented in thousands of ICUs. (6–9)Each component of the ABCDEF bundle addresses a target practice in the ICU independently associated with patient safety or patient-centered outcomes. (10–26) For example, multiple studies have demonstrated the efficacy of implementing combined SATs and SBTs to shorten duration of mechanical ventilation and ICU length of stay.…”

Section: Introductionmentioning

confidence: 99%

Worldwide Survey of the “Assessing Pain, Both Spontaneous Awakening and Breathing Trials, Choice of Drugs, Delirium Monitoring/Management, Early Exercise/Mobility, and Family Empowerment” (ABCDEF) Bundle

Morandi

Piva

Ely

et al. 2017

Critical Care Medicine

Self Cite

207

141

View full text Add to dashboard Cite

Objective To assess the knowledge and use of the ABCDEF bundle to implement the Pain, Agitation, Delirium (PAD) guidelines. Design Worldwide On-line Survey. Setting Intensive care. Intervention A cross-sectional online survey using the Delphi method was administered to intensivists worldwide, to assess the knowledge and use of all aspects of the ABCDEF bundle (Assessment, prevention and management of pain; spontaneous awakening and Breathing trials; Choice of analgesia and sedation; Delirium assessment; Early mobility and exercise and Family engagement and empowerment.) Measurement and Main Results There were 1521 respondents from 47 countries, 57% had implemented the ABCDEF bundle, with varying degrees of compliance across continents. Most of the respondents (83%) used a scale to evaluate pain. SATs and SBTs are performed in 66% and 67% of the responder ICUs respectively. Sedation scale was used in 89% of ICUs. Delirium monitoring was implemented in 70% of ICUs, but only 42% used a validated delirium tool. Likewise, early mobilization was “prescribed” by most but 69% had no mobility team and 79% used no formal mobility scale. Only 36% of the respondents assessed ICU acquired weakness. Family members were actively involved in 67% of ICUs, however only 33% used dedicated staff to support families and only 35% reported that their unit was open 24 hours/day for family visits. Conclusions The current implementation of the ABCDEF bundle varies across individual components and regions. We identified specific targets for quality improvement and adoption of the ABCDEF bundle. Our data reflect a significant but incomplete shift towards patient- and family-centered ICU care in accordance with the PAD guidelines.

show abstract

“…One example is the complex care required in ICU delirium prevention and management interventions. ICU delirium is a common complication of ICU patients with a high incidence of 70% to 87% (Klein et al, ) and associated with longer hospital length of stay (LOS) and increased mortality (Barnes‐Daly, Phillips, & Ely, ; Devlin et al, ). Guidelines recommend use of the bundle intervention as a way to prevent and manage ICU delirium (Devlin et al, ).…”

Section: Introductionmentioning

confidence: 99%

Psychometric properties of the Chinese version of the instrument for measuring different types of cognitive load (MDT‐CL)

Zhang

et al. 2020

J Nurs Manag

View full text Add to dashboard Cite

Aim To translate the instrument for measuring different types of cognitive load (MDT‐CL) into Chinese and assess the reliability and validity of the Chinese version of the MDT‐CL. Background The MDT‐CL is needed for hospital administrators to identify which nursing staff are prone to high cognitive load and to provide tailored interventions for specific types of cognitive load. Methods The MDT‐CL was translated into Chinese using forward and back translation, cultural adaptation and pilot tested. The reliability and validity of the instrument were assessed with intensive care unit (ICU) nurses in three tertiary hospitals in China. Results A total of 222 ICU nurses were recruited. The scale‐content validity index of the Chinese version of the MDT‐CL was 0.966. Confirmatory factor analysis indicated that all the goodness‐of‐fit indicators were acceptable. Cronbach's α coefficient was 0.818. Test–retest reliability was 0.785. Conclusions The Chinese version of the MDT‐CL is a valid and reliable instrument for evaluating the cognitive load of ICU nurses in China. Implications for nursing management The validated Chinese version of the MDT‐CL is a feasible, quantitative tool for evaluating different types of cognitive load in busy clinical practice, suggesting significant clinical application value.

show abstract

Improving Hospital Survival and Reducing Brain Dysfunction at Seven California Community Hospitals: Implementing PAD Guidelines Via the ABCDEF Bundle in 6,064 Patients*

Cited by 338 publications

References 37 publications

ICU delirium ― a diagnostic and therapeutic challenge in the intensive care unit

ICU delirium ― a diagnostic and therapeutic challenge in the intensive care unit

Worldwide Survey of the “Assessing Pain, Both Spontaneous Awakening and Breathing Trials, Choice of Drugs, Delirium Monitoring/Management, Early Exercise/Mobility, and Family Empowerment” (ABCDEF) Bundle

Psychometric properties of the Chinese version of the instrument for measuring different types of cognitive load (MDT‐CL)

Contact Info

Product

Resources

About