Evaluating the Effectiveness of a Multicomponent Care Bundle Among Intubated Patients

Abstract

Problem: At a community hospital, the current intensive care unit (ICU) length of stay (LoS) is increasing. In January 2021, the LoS was 3.84 days, and in December 2020, it was 3.0. Also, it is above the average ICU LoS in the United States, which according to the Society of Critical Care medicine, is 3.8 days. Prolonged LoS can lead to ICU delirium, higher hospital bill costs, decreased quality of life, long-term physical impairments, and is associated with increased risk of long-term mortality after hospital discharge. Purpose: The purpose of this quality improvement project is to implement and evaluate the effectiveness of the ABCDEF bundle in an adult medical/surgical ICU. ABCDEF stands for: assess, prevent, and manage pain; both spontaneous awakening and breathing trials; choice of analgesic/sedation; delirium: assess, prevent, and manage; early mobility and exercise; and family engagement. It is anticipated that the implementation of this bundle could result in a shortened LoS among intubated patients. Methods: Data was collected using an observational checklist adopted from the Society of Critical Care Medicine’s website. All nurses were educated on how to use this tool. The tool was completed once a day, around the time of rounds, by charge nurses to assess which of the ABCDEF bundle elements were applied to intubated patients. The observational checklists were collected and analyzed weekly. Results: By the end of the implementation phase, 100% of staff nurses have received education on patient eligibility for the bundle, 22.9% of intubated patients (who met criteria) received all components of the ABCDEF bundle, and 67.4% of intubated patients were assessed via Observational Checklist, and the average LoS during the 15 weeks was 7.53 days. Conclusions: Though LoS was not decreased, progress was achieved. Nurses demonstrated proficient skills when applying the bundle to patients and nurses gained confidence in initiating SAT/SBTs and early-mobility practices. Post-implementation the SAT/SBT provider order became available for use in EPIC and the SAT/SBT policy has been updated and published on the institution’s intranet. Limitations such as high staff turnover may have negatively impacted this project.