DETERMINANTS OF ABCDE BUNDLE IMPLEMENTATION BY HEALTHCARE PROVIDERS AT COAST GENERAL TEACHING AND REFERRAL HOSPITAL CRITICAL CARE UNIT, MOMBASA COUNTY KENYA.
Abstract
Background. The Awakening, Breathing, Choice of analgesic and sedation, Delirium management and prevention and early Exercise/mobility (ABCDE) is evidenced based protocol associated with improved outcome of the critically ill patients. Fully implementation of this protocol optimizes the outcome of the mechanically ventilated patients.
Objective. The study explored the determinants of ABCDE bundle implementation by healthcare providers Coast general teaching and referral hospital critical care unit.
Methods. The study used descriptive design to explore the determinants that influence the ABCDE bundle implementation. Data collection was done through structured questionnaires in form of Likert scale. Study participants were selected using census sampling method. A total of (N=60) participants were involved in the study. Data was analysed using statistical package of social sciences (SPSS) version 25.
Results. A total of 60 questionnaires were collected from the participants. The results showed that female were the majority of the participants with 68.3% (n=41). Majority of the participants were between 30-39 age group with 38.3% (n=23). The results further revealed that nursing profession contributed the majority of the participants with 75% (n=45). The results also showed that most of the participants had diploma as their level of education with 65% (n=39). Furthermore, the results revealed that majority of the participants had experience of 1-2 years. Additionally, the results revealed that implementation of the bundle varied with 71.7% (n=43) implementing SAT, 66.7% (n=40) SBT, 63.3% (n=38) pain, 75% (n=45) sedation, 75% (n=45) delirium and 76% (n=46) early exercise/mobility. Bivariate analysis of healthcare providers’ factors showed that both knowledge and experience has relationship with ABCDE bundle implementation. Similarly bivariate analysis of the healthcare system factors revealed that workload, staffing, protocol availability and training are both significantly related to the implementation of the bundle. Multivariate analysis using logistic regression revealed that knowledge predicts bundle implementation with p=0.009, experience with p=0.049, workload with p=0.021, protocol with p=0.029, training with p=0.035 and staffing with p=0.007.
Conclusion. ABCDE bundle implementation is influenced by both healthcare provider factors and healthcare system factors as revealed by this study.
Key words: Sedation, mechanically ventilation, spontaneous breathing trial, delirium.
Keywords
Full Text:
PDFReferences
Boehm, B. L. M., Dietrich, M. S., Vasilevskis, E. E., Wells, N., Pandharipande, P., Ely, E. W., & Mion, L. C. (2017). Abcde b. 26(4).
Boehm, L. M., Dietrich, M. S., Vasilevskis, E. E., Wells, N., Pandharipande, P., Ely, E. W., & Mion, L. C. (2018). Perceptions of Workload Burden and Adherence to ABCDE Bundle Among Intensive Care Providers. 26(4), 1–16. https://doi.org/10.4037/ajcc2017544.Perceptions
Boehm, L. M., Vasilevskis, E. E., & Mion, L. C. (2016). Interprofessional Perspectives on ABCDE Bundle Implementation. Dimensions of Critical Care Nursing, 35(6), 339–347. https://doi.org/10.1097/DCC.0000000000000208
Bounds, B. M., Kram, S., Speroni, K. G., Brice, K., Anne, M., Harte, S., & Daniel, M. G. (2016). B i p d i c u p. 25(6), 535–544.
Costa, D. K., White, M. R., Ginier, E., Manojlovich, M., Govindan, S., Iwashyna, T. J., & Sales, A. E. (2017). Identifying Barriers to Delivering the Awakening and Breathing Coordination, Delirium, and Early Exercise/Mobility Bundle to Minimize Adverse Outcomes for Mechanically Ventilated Patients: A Systematic Review. Chest, 152(2), 304–311. https://doi.org/10.1016/j.chest.2017.03.054
Dayton, C., Levi, D., Garcia, M., Mills, M., Fein, D., Colman, S., & Gong, M. N. (2020). HHS Public Access. 47(7), 885–893. https://doi.org/10.1097/CCM.0000000000003765.Staged
Dietrich, M. S., Wells, N., Ely, E. W., & Mion, L. C. (2017a). Abcde b. 26(3), 18–28.
Dietrich, M. S., Wells, N., Ely, E. W., & Mion, L. C. (2017b). Abcde b. 26(3), 18–27.
El-demerdash, S. M., & Obied, H. K. (2018). Intensive Care Unit Nurses ’ Uncertainty and Patient Safety Culture. 3(1), 110–122. https://doi.org/10.20849/ijsn.v3i1.345
Elfil, M., & Negida, A. (2019). Sampling methods in clinical research; an educational review. Archives of Academic Emergency Medicine, 7(1), 3–5. https://doi.org/10.22037/emergency.v5i1.15215
Govindan, S., Iwashyna, T. J., & Anne, E. (2018). systematic review. 152(June 2015), 304–311. https://doi.org/10.1016/j.chest.2017.03.054.Identifying
Hanson, L. (2019). OpenRiver Efficacy of the ABCDE Bundle in Reducing Delirium in Critically Ill Patients : An Integrative Literature Review.
Hermes, C., Acevedo-Nuevo, M., Berry, A., Kjellgren, T., Negro, A., & Massarotto, P. (2018). Gaps in pain, agitation and delirium management in intensive care: Outputs from a nurse workshop. Intensive and Critical Care Nursing, 48(2018), 52–60. https://doi.org/10.1016/j.iccn.2018.01.008
Huang, X., Lei, L., Zhang, S., Yang, J., & Yang, L. (2021). Implementation of the “ awakening and breathing trials , choice of drugs , delirium management , and early exercise / mobility ” bundle in the pediatric intensive care unit of tertiary hospitals in southwestern China : a cross-sectional survey. 20. https://doi.org/10.1177/0300060520987770
Jayamalli, M. N., & Priya, M. D. J. (2020). Conceptual Framework for the study based on Ernestine wiedenbach helping art of clinical nursing theory - for coping and quality of life among perimenopausal women. 23(23).
Kelly, D., Rn, C., Bsn, M. R. W., Mlis, E. G., Manojlovich, M., Ccrn, R. N., Govindan, S., Iwashyna, T. J., & Rn, A. E. S. (2017). Identifying Barriers to Delivering the Awakening and Breathing Coordination , Delirium , and Early Exercise / Mobility Bundle to Minimize Adverse Outcomes for Mechanically Ventilated Patients. CHEST, 152(2), 304–311. https://doi.org/10.1016/j.chest.2017.03.054
Kotfis, K., Roberson, S. W., Wilson, J. E., Dabrowski, W., Pun, B. T., & Ely, E. W. (2020). COVID-19 : ICU delirium management during SARS-CoV-2 pandemic. December. https://doi.org/10.1186/s13054-020-02882-x
Kotfis, K., Roberson, S. W., Wilson, J. E., & Pun, B. T. (2020). COVID-19 : What do we need to know about ICU delirium during the SARS-CoV-2 pandemic ? May. https://doi.org/10.5114/ait.2020.95164
Kram, S. L., Dibartolo, M. C., Hinderer, K., & Jones, R. A. (2015). Implementation of the ABCDE Bundle to Improve Patient Outcomes in the Intensive Care Unit in a Rural Community Hospital. Dimensions of Critical Care Nursing, 34(5), 250–258. https://doi.org/10.1097/DCC.0000000000000129
Marra, A., Ely, E. W., Pandharipande, P. P., & Patel, M. B. (2018). The ABCDEF Bundle in Critical Care. 33(2), 225–243. https://doi.org/10.1016/j.ccc.2016.12.005.The
Mart, M. F., Brummel, N. E., & Ely, E. W. (2019). The ABCDEF Bundle for the Respiratory Therapist. Respiratory Care, 64(12), 1561–1573. https://doi.org/10.4187/respcare.07235
Mnsc, H. W. (2020). Movements and trends in intensive care pain treatment and sedation : What matters to the patient ? June 2019, 1129–1140. https://doi.org/10.1111/jocn.15179
Ouellette, D. R., Patel, S., Girard, T. D., Morris, P. E., Schmidt, G. A., Truwit, J. D., Alhazzani, W., Burns, S. M., Epstein, S. K., Esteban, A., Fan, E., Ferrer, M., Fraser, G. L., Gong, M. N., Hough, C. L., Mehta, S., Nanchal, R., Pawlik, A. J., Schweickert, W. D., … Kress, J. P. (2017). Liberation From Mechanical Ventilation in Critically Ill Adults: An Official American College of Chest Physicians/American Thoracic Society Clinical Practice Guideline: Inspiratory Pressure Augmentation During Spontaneous Breathing Trials, Protocols Minim. Chest, 151(1), 166–180. https://doi.org/10.1016/j.chest.2016.10.036
Pauline, M. (2015). Evaluation of nurses’ knowledge and prevention practices of ventilator associated morbidities in critical care unit, Kenyatta national hospital. Journal of Critical Care.
Sneyers, B., Henrard, S., Laterre, P. F., Perreault, M. M., Beguin, C., Wouters, D., Speybroeck, N., & Spinewine, A. (2017). Predictors of clinicians’ underuse of daily sedation interruption and sedation scales. Journal of Critical Care, 38, 182–189. https://doi.org/10.1016/j.jcrc.2016.07.021
Sosnowski, K., Mitchell, M. L., White, H., Morrison, L., Sutton, J., Sharratt, J., & Lin, F. (2018). A feasibility study of a randomised controlled trial to examine the impact of the ABCDE bundle on quality of life in ICU survivors. Pilot and Feasibility Studies, 4(1), 1–12. https://doi.org/10.1186/s40814-017-0224-x
Stollings, J. L., Devlin, J. W., Lin, J. C., Pun, B. T., Byrum, D., & Barr, J. (2020). Best practices for conducting interprofessional team rounds to facilitate performance of the ICU liberation (ABCDEF) bundle. Critical Care Medicine, 48(4), 562–570. https://doi.org/10.1097/CCM.0000000000004197
Tool, C. P. O., & Bardwell, J. (2020). Implementing the ABCDE Bundle , and Richmond Agitation-Sedation. 31(1), 16–21.
Weiss, C. H. (2017). Why do we fail to deliver evidence-based practice in critical care medicine? Current Opinion in Critical Care, 23(5), 400–405. https://doi.org/10.1097/MCC.0000000000000436
Wyler, D., Esterlis, M., Dennis, B. B., Ng, A., & Lele, A. (2018). Challenges of pain management in neurologically injured patients: Systematic review protocol of analgesia and sedation strategies for early recovery from neurointensive care. Systematic Reviews, 7(1), 1–10. https://doi.org/10.1186/s13643-018-0756-z
Refbacks
- There are currently no refbacks.
Copyright (c) 2024 Thomas Mwalimu Kahindi
© Numid Publishers ISSN: 2518-8631