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

Stollings, Joanna L. PharmD
Devlin, John W. PharmD
Pun, Brenda T. DNP, RN
Puntillo, Kathleen A. PhD, RN
Kelly, Tamra MHA, RRT
Hargett, Ken D. MHA, RRT
Morse, Alexandra PharmD
Esbrook, Cheryl L. OTR/L, BCPR
Engel, Heidi J. DPT
Perme, Christiane PT, CCS
Barnes-Daly, Mary Ann MS, RN, DC
Posa, Patricia J. MSA, BSN, CCRN-K
Aldrich, Matthew J. MD
Barr, Juliana MD
Carson, Shannon S. MD
Schweickert, William D. MD
Byrum, Diane G. MSN, RN, CCNS, CCRN-K
Harmon, Lori MBA, RRT
Ely, Wesley E. MD, MPH
Balas, Michele C. PhD, RN, CCRN-K

Joanna Stollings is a clinical pharmacist, Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, Tennessee.
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.
Brenda Pun is an advanced practice nurse, Vanderbilt University Medical Center.
Kathleen Puntillo is a professor of nursing emeritus, Department of Physiological Nursing, School of Nursing, University of California, San Francisco.
Tamra Kelly is a respiratory therapist, Sutter Health, Sacramento, California.
Ken Hargett is a respiratory therapist, Houston Methodist Hospital, Houston, Texas.
Alexandra Morse is a clinical pharmacist, Sutter Health.
Cheryl Esbrook is an occupational therapist, University of Chicago Medicine, Chicago, Illinois.
Heidi Engel is a physical therapist, Department of Rehabilitative Services, University of California, San Francisco.
Christiane Perme is a physical therapist, Houston Methodist Hospital.
Mary Ann Barnes-Daly is a clinical performance improvement consultant, Sutter Health.
Patricia Posa is a population health clinical integration leader, Saint Joseph Mercy Health System, Ann Arbor, Michigan.
J. Matthew Aldrich is the Medical Director of Critical Care Medicine and an associate clinical professor, University of San Francisco, San Francisco.
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.
Shannon Carson is a critical care pulmonologist, University of North Carolina School of Medicine, Chapel Hill.
William Schweickert is an associate professor of clinical medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Diane Byrum is a quality implementation consultant, Innovative Solutions for Healthcare Education, LLC, Charlotte, North Carolina.
Lori Harmon is director of quality, Society of Critical Care Medicine, Mount Prospect, Illinois.
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.
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.

Corresponding author: Joanna L. Stollings, PharmD, 1211 Medical Center Dr, BUH-131, Nashville, TN 37232 (email:[email protected]).

To purchase electronic or print reprints, contact the American Association of Critical-Care Nurses, 101 Columbia, Aliso Viejo, CA 92656. Phone, (800) 899-1712 or (949) 362-2050 (ext 532); fax, (949) 362-2049; email,[email protected].

Financial Disclosures

Financial support for the SCCM's ABCDEF Bundle Improvement Collaborative was provided by the Gordon and Betty Moore Foundation. Dr Puntillo, Dr Barnes-Daly, and Dr Aldrich have received funding from the Gordon and Betty Moore Foundation; Dr Aldrich has also received funding from the National Institutes of Health. Ms Posa has received honoraria from ICU Medical. Dr Barr is a member of the medical advisory panel for Medasense and is a scientific advisor for Masimo. Dr Carson received funding from the National Institute of Nursing Research and Biomarck Pharmaceuticals for ongoing research. Dr Ely is the principal investigator of the ICU Liberation Collaborative as appointed by the SCCM. He has received honoraria for continuing medical education activities sponsored by Pfizer, Abbott, and Orion. He receives funding from the National Institutes of Health and Veterans Affairs federal agencies for ongoing research. Dr Balas currently receives funding through a grant from Select Medical. Dr Stollings, Dr Devlin, Dr Pun, Ms Kelly, Mr Hargett, Dr Morse, Ms Esbrook, Dr Engel, Mrs Perme, Dr Schweickert, Ms Byrum, and Ms Harmon have nothing to disclose.

eLetters

Now that you've read the article, create or contribute to an online discussion about this topic using eLetters. Just visit www.ccnonline.org and select the article you want to comment on. In the full-text or PDF view of the article, click “Responses” in the middle column and then “Submit a response.”

See also

To learn more about the ABCDEF bundle, read “Effect of ABCDE Bundle Implementation on Prevalence of Delirium in Intensive Care Unit Patients” by Bounds et al in the American Journal of Critical Care, November 2016;25:535-544. Available at www.ajcconline.org.

Critical Care Nurse 39(1):p 36-45, February 2019. | DOI: 10.4037/ccn2019981

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.