Worldwide Survey of the "Assessing Pain, Both Spontaneous Awakening and Breathing Trials, Choice of Drugs, Delirium Monitoring/Management, Early Exercise/Mobility, and Family Empowerment" (ABCDEF) Bundle
Morandi, Alessandro; Piva, Simone; Ely, E Wesley; Myatra, Sheila Nainan; Salluh, Jorge I F; Amare, Dawit; Azoulay, Elie; Bellelli, Giuseppe; Csomos, Akos; Fan, Eddy; Fagoni, Nazzareno; Girard, Timothy D; Heras La Calle, Gabriel; Inoue, Shigeaki; Lim, Chae-Man; Kaps, Rafael; Kotfis, Katarzyna; Koh, Younsuck; Misango, David; Pandharipande, Pratik P; Permpikul, Chairat; Cheng Tan, Cheng; Wang, Dong-Xin; Sharshar, Tarek; Shehabi, Yahya; Skrobik, Yoanna; Singh, Jeffrey M; Slooter, Arjen; Smith, Martin; Tsuruta, Ryosuke; Latronico, Nicola
(2017) Critical Care Medicine, volume 45, issue 11, pp. e1111 - e1122
(Article)
Abstract
OBJECTIVES: To assess the knowledge and use of the Assessment, prevention, and management of pain; spontaneous awakening and breathing trials; Choice of analgesia and sedation; Delirium assessment; Early mobility and exercise; and Family engagement and empowerment (ABCDEF) bundle to implement the Pain, Agitation, Delirium guidelines. DESIGN: Worldwide online survey. SETTING:
... read more
Intensive care. INTERVENTION: A cross-sectional online survey using the Delphi method was administered to intensivists worldwide, to assess the knowledge and use of all aspects of the ABCDEF bundle. MEASUREMENT AND MAIN RESULTS: There were 1,521 respondents from 47 countries, 57% had implemented the ABCDEF bundle, with varying degrees of compliance across continents. Most of the respondents (83%) used a scale to evaluate pain. Spontaneous awakening trials and spontaneous breathing trials are performed in 66% and 67% of the responder ICUs, respectively. Sedation scale was used in 89% of ICUs. Delirium monitoring was implemented in 70% of ICUs, but only 42% used a validated delirium tool. Likewise, early mobilization was "prescribed" by most, but 69% had no mobility team and 79% used no formal mobility scale. Only 36% of the respondents assessed ICU-acquired weakness. Family members were actively involved in 67% of ICUs; however, only 33% used dedicated staff to support families and only 35% reported that their unit was open 24 hr/d for family visits. CONCLUSIONS: The current implementation of the ABCDEF bundle varies across individual components and regions. We identified specific targets for quality improvement and adoption of the ABCDEF bundle. Our data reflect a significant but incomplete shift toward patient- and family-centered ICU care in accordance with the Pain, Agitation, Delirium guidelines.
show less
Download/Full Text
The full text of this publication is not available.
Keywords: Adult, Aged, Cross-Sectional Studies, Delirium, Early Ambulation, Family, Humans, Intensive Care Units, Knowledge, Medicine, Middle Aged, Pain Management, Pain Measurement, Patient Care Bundles, Physicians, Respiration
ISSN: 0090-3493
Publisher: Lippincott Williams and Wilkins
Note: Publisher Copyright: Copyright © 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
(Peer reviewed)