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Moving Forward with ABCDE Bundle
Transcript of Moving Forward with ABCDE Bundle
Choice of sedation
The key is in Detection using proven tools such as CAM-ICU
Delirium Monitoring and Management
Delirium Protocol with ABCDE bundle integrated which summarizes the management of delirious mechanically vented patients.
Incorporate power plans into Cerner
Challenge in Leadership
Barriers to Compliance
Lack of Team work
Training and Having enough help
The Wright Brothers have no formal college education.
They didn't have enough funds to get their experiments done.
All the people have thought that it is impossible to fly.
But the Wright brothers have the will and right mind set. They simply want to fly.
It can be done
The transition from bicycle to flying airplane was the result of years of experimentations but it all started with the idea that we can glide in the air and fly.
- All Mechanical Ventilated patients
Exclusion : (are not absolute and changeable)
- neuromuscular blockers
- increasing ICP
- ongoing MI
- active seizure or alcohol withdrawal
Paired SAT and SBT Workflow
- Sedation Vacation at the beginning of the shift
- If sedation is still needed, start at half the previous dose
- Wean off sedation at the end of the shift.
- Sedation vacation is a process and not an abrupt interruption
Importance of Documenting Sedation Vacations
Will finalize in Cerner after project is finished
This is good SBAR tool to facilitate bedside reporting
HUDDLE GUIDE as Documentation Tool
Trend in ABCDE adaptation
Strategy in Incorporating ABCDE Bundle Into Practice
Review of the ABCDE Bundle
Rationale of Exclusion Criteria
Documenting into the Huddle Guide
RASS scoring and causes of agitation
I. Extensive Research
a) Knowledge of evidences.
b) Facilitators and Barriers to ABCDE
II. Strategies to Incorporate
a) Multidisciplinary approach
b) Change Team
c) Current Practice Environment
d) Documentation Strategies
Lighter sedation and benzo- sparring can lead to:
- shorter days on mechanical
- shorter ICU stays
- shorter hospital stays
- less complications
- lesser rehabilitation time
Increasing Number of Evidences Against Oversedation in ICU
Break the cycle
It's a vicious cycle that increases complications
Benefits of Early Mobility
Integration of the ABCDE Bundle is an emerging standard of practice.
A mobilization and an early exercise intervention in ICU patients reduce the incidence and shorter duration of ICU delirium (Schweickert, et al., 2009)
RCPs Role in Implementing the "ABCDE Bundle"
It started with a simple observation of delirious patients post extubation.
We challenged the status quo and discovered the ABCDE bundle.
- By doing sedation vacations
every shift, we are able to assess patients' neuro status and optimize their sedation needs.
Vasilevskis et al Chest 2010; 138;1224-1233
Cognitive and Functional Impairment, Institutionalization, Mortality
Patient with Sepsis
Risks of Mechanical Ventilation
Short Term Wins
Wean sedation then SAT
New Skill Set to Learn
Patient Extubation Checklist
- Follows Commands
- Not agitated
- ETT leak test
Research other methods of weaning
the mechanical ventilation
Get people on board and identify