Implementing the ABCDEF Bundle: Top 8 Questions Asked During the ICU Liberation ABCDEF Bundle Improvement Collaborative

Joanna L Stollings; John W Devlin; Brenda T Pun; Kathleen A Puntillo; Tamra Kelly; Ken D Hargett; Alexandra Morse; Cheryl L Esbrook; Heidi J Engel; Christiane Perme; Mary Ann Barnes-Daly; Patricia J Posa; J Matthew Aldrich; Juliana Barr; Shannon S Carson; William D Schweickert; Diane G Byrum; Lori Harmon; E Wesley Ely; Michele C Balas

doi:10.4037/ccn2019981

Implementing the ABCDEF Bundle: Top 8 Questions Asked During the ICU Liberation ABCDEF Bundle Improvement Collaborative

Crit Care Nurse. 2019 Feb;39(1):36-45. doi: 10.4037/ccn2019981.

Authors

Joanna L Stollings¹, John W Devlin², Brenda T Pun³, Kathleen A Puntillo⁴, Tamra Kelly⁵, Ken D Hargett⁶, Alexandra Morse⁷, Cheryl L Esbrook⁸, Heidi J Engel⁹, Christiane Perme¹⁰, Mary Ann Barnes-Daly¹¹, Patricia J Posa¹², J Matthew Aldrich¹³, Juliana Barr¹⁴, Shannon S Carson¹⁵, William D Schweickert¹⁶, Diane G Byrum¹⁷, Lori Harmon¹⁸, E Wesley Ely¹⁹, Michele C Balas²⁰

Affiliations

¹ Joanna Stollings is a clinical pharmacist, Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, Tennessee. joanna.stollings@vanderbilt.edu.
² John Devlin is Professor of Pharmacy, Northeastern University, and a clinical scientist, Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Boston, Massachusetts.
³ Joanna Stollings is a clinical pharmacist, Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, Tennessee.
⁴ Kathleen Puntillo is a professor of nursing emeritus, Department of Physiological Nursing, School of Nursing, University of California, San Francisco.
⁵ Tamra Kelly is a respiratory therapist, Sutter Health, Sacramento, California.
⁶ Ken Hargett is a respiratory therapist, Houston Methodist Hospital, Houston, Texas.
⁷ Alexandra Morse is a clinical pharmacist, Sutter Health.
⁸ Cheryl Esbrook is an occupational therapist, University of Chicago Medicine, Chicago, Illinois.
⁹ Heidi Engel is a physical therapist, Department of Rehabilitative Services, University of California, San Francisco.
¹⁰ Christiane Perme is a physical therapist, Houston Methodist Hospital.
¹¹ Mary Ann Barnes-Daly is a clinical performance improvement consultant, Sutter Health.
¹² Patricia Posa is a population health clinical integration leader, Saint Joseph Mercy Health System, Ann Arbor, Michigan.
¹³ J. Matthew Aldrich is the Medical Director of Critical Care Medicine and an associate clinical professor, University of San Francisco, San Francisco.
¹⁴ Juliana Barr is a staff intensivist and anesthesiologist, VA Palo Alto Health Care System, Palo Alto, California, and an associate professor, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California.
¹⁵ Shannon Carson is a critical care pulmonologist, University of North Carolina School of Medicine, Chapel Hill.
¹⁶ William Schweickert is an associate professor of clinical medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
¹⁷ Diane Byrum is a quality implementation consultant, Innovative Solutions for Healthcare Education, LLC, Charlotte, North Carolina.
¹⁸ Lori Harmon is director of quality, Society of Critical Care Medicine, Mount Prospect, Illinois.
¹⁹ E. Wesley Ely is a professor of medicine, Vanderbilt University School of Medicine, and associate director, VA Tennessee Valley Geriatric Research Education Clinical Center, Nashville, Tennessee.
²⁰ Michele Balas is an associate professor, Center of Excellence in Critical and Complex Care, College of Nursing, and a nurse scientist, Wexner Medical Center, The Ohio State University, Columbus.

PMID: 30710035
DOI: 10.4037/ccn2019981

Abstract

The ABCDEF bundle (A, assess, prevent, and manage pain; B, both spontaneous awakening and spontaneous breathing trials; C, choice of analgesic and sedation; D, delirium: assess, prevent, and manage; E, early mobility and exercise; and F, family engagement and empowerment) improves intensive care unit patient-centered outcomes and promotes interprofessional teamwork and collaboration. The Society of Critical Care Medicine recently completed the ICU Liberation ABCDEF Bundle Improvement Collaborative, a 20-month, multicenter, national quality improvement initiative that formalized dissemination and implementation strategies to promote effective adoption of the ABCDEF bundle. The purpose of this article is to describe 8 of the most frequently asked questions during the Collaborative and to provide practical advice from leading experts to other institutions implementing the ABCDEF bundle.

MeSH terms

Cooperative Behavior
Critical Care / standards*
Critical Illness / therapy*
Evidence-Based Practice / standards
Humans
Intensive Care Units / standards*
Patient Care Bundles / standards*
Quality Improvement*