Assess, Prevent, and Manage Pain; Both Spontaneous Awakening and Breathing Trials; Choice of Analgesia/Sedation; Delirium: Assess, Prevent, and Manage; Early Mobility; Family Engagement and Empowerment Bundle Implementation: Quantifying the Association of Access to Bundle-Enhancing Supplies and Equipment. (14th September 2021)

• Record Type: Journal Article
• Authors: Jeffery, Alvin D.; Werthman, Jennifer A.; Danesh, Valerie; Dietrich, Mary S.; Mion, Lorraine C.; Boehm, Leanne M.
• Is Part Of: Critical care explorations. Volume 3:Number 9(2021)
• Page Start: e0525
• Publication Date: 2021-09-14
• Subjects: ABCDEF bundle -- critical care -- environment -- evidence-based design -- intensive care unit -- interdisciplinary
• DOI: 10.1097/CCE.0000000000000525
• Languages: English
• ISSNs: 2639-8028

Abstract

Abstract : Supplemental Digital Content is available in the text. Abstract : OBJECTIVES: Describe the physical environment factors (i.e., availability, accessibility) of bundle-enhancing items and the association of physical environment with bundle adherence. DESIGN: This multicenter, exploratory, cross-sectional study used data from two ICU-based randomized controlled trials that measured daily bundle adherence. Unit- and patient-level data collection occurred between 2011 and 2016. We developed hierarchical logistic regression models using Frequentist and Bayesian frameworks. SETTING: The study included 10 medical and surgical ICUs in six academic medical centers in the United States. PATIENTS: Adults with qualifying respiratory failure and/or septic shock (e.g., mechanical ventilation, vasopressor use) were included in the randomized controlled trials. INTERVENTIONS: The Awakening and Breathing trial Coordination, Delirium assessment/management, Early mobility bundle was recommended standard of care for randomized controlled trial patients and adherence tracked daily. MEASUREMENTS AND MAIN RESULTS: The primary outcome was adherence to the full bundle and the early mobility bundle component as identified from daily adherence documentation ( n = 751 patient observations). Models included unit-level measures such as minimum and maximum distances to bundle-enhancing items and patient-level age, body mass index, and daily mechanical ventilation status. Some models suggested the following variables were influential: unit size (larger associated with decreased adherence), a standard walker (presence associated with increased adherence), and age (older associated with decreased adherence). In all cases, mechanical ventilation was associated with decreased bundle adherence. CONCLUSIONS: Both unit- and patient-level factors were associated with full bundle and early mobility adherence. There is potential benefit of physical proximity to essential items for Awakening and Breathing trial Coordination, Delirium assessment/management, Early mobility bundle and early mobility adherence. Future studies with larger sample sizes should explore how equipment location and availability influence practice.