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Moving Forward with ABCDE Bundle

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by

Glenn Siy

on 1 May 2014

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Transcript of Moving Forward with ABCDE Bundle

ABCDE Bundle Implementation Strategy
Awakening
Breathing
Choice of sedation
The key is in Detection using proven tools such as CAM-ICU
Delirium Monitoring and Management
THINK
ICUDELIRIUMS
IWATCHDEATH
Management
Delirium Protocol
Delirium Protocol with ABCDE bundle integrated which summarizes the management of delirious mechanically vented patients.
Incorporate power plans into Cerner

Flowcharts

Challenge in Leadership

Cultural expectation

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.



Inclusion :
- All Mechanical Ventilated patients

Exclusion : (are not absolute and changeable)
- neuromuscular blockers
- increasing ICP
- ongoing MI
- active seizure or alcohol withdrawal
- agitation
Paired SAT and SBT Workflow
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
of sedation.
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

Workflow

Documenting into the Huddle Guide

RASS scoring and causes of agitation




Conclusion
Any Questions?
I. Extensive Research
a) Knowledge of evidences.

b) Facilitators and Barriers to ABCDE
Bundle Adaption.
II. Strategies to Incorporate
a) Multidisciplinary approach

b) Change Team

c) Current Practice Environment

d) Documentation Strategies
Early Mobility
Goals
Lighter sedation and benzo- sparring can lead to:
- shorter days on mechanical
ventilator
- 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"
Phase I
Phase II
Phase III
ABC
D
E
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

Weakness

Delirium

Mechanical
Ventilation

Over sedation

Risks of Mechanical Ventilation
Short Term Wins
Fentanyl
Precedex
Propofol
Versed
Ativan
Extubation
Sedation Vacation
then SBT
Wean sedation then SAT
New Skill Set to Learn
Challenges:

Patient Extubation Checklist
- Awake
- Follows Commands
- Not agitated
- cooperative
- ETT leak test
- RSBI
Research other methods of weaning
the mechanical ventilation
Get people on board and identify
barriers
Full transcript