Jacqueline M DeMellow1, Tae Youn Kim2, Patrick S Romano3, Christiane Drake4, Michele C Balas5. 1. Dignity Health St Joseph's Medical Center, 1800 N California St, Stockton, CA 95204, USA. Electronic address: Jacquie.demellow@dignityhealth.org. 2. University of California Davis, Betty Irene Moore School of Nursing, 2450 48th St, Suite 2600, Sacramento, CA 95817, USA. Electronic address: tynkim@ucdavis.edu. 3. University of California Davis, Division of General Medicine, 4860 Y St, Suite 400, Sacramento, CA 95817, USA. Electronic address: psromano@ucdavis.edu. 4. University of California Davis, Department of Statistics, One Shields Avenue, 4101 Mathematical Sciences Building, Davis, CA 95616, USA. Electronic address: cmdrake@ucdavis.edu. 5. The Ohio State University College of Nursing, Center of Excellence in Critical and Complex Care, Columbus, OH 43210, USA. Electronic address: balas.17@osu.edu.
Abstract
OBJECTIVE: To identify factors associated with the ABCDEF bundle (Assess, prevent, and manage pain, Both, spontaneous awakening and breathing trials, Choice of sedation/analgesia, Delirium assess, prevent and manage, Early mobility/exercise and Family engagement/empowerment) adherence, in critically ill patients during the first 96 hours of mechanical ventilation. DESIGN: Observational study using electronic health record data. SETTING: 15 intensive care units located in seven community hospitals in a western United States health system. PATIENTS: 977 adult patients who were on mechanical ventilation for greater than 24 hours and admitted to an intensive care unit over six months. MEASUREMENTS AND MAIN RESULTS: Multiple regression analysis was used to examine factors contributing to bundle adherence while adjusting for severity of illness, days on mechanical ventilation, hospital site and time elapsed. ABCDEF bundle adherence was higher in patients on mechanical ventilation for less than 48 hours (p = 0.01), who received continuous sedation for less than 24 hours (p < 0.001), admitted from skilled nursing facilities (p < 0.05), and over the course of the six-month study period (p < 0.01). Bundle adherence was significantly lower for Hispanic patients (p < 0.01). CONCLUSIONS: Our study identified potentially modifiable factors that could improve the team's performance of the ABCDEF bundle in patients requiring mechanical ventilation.
OBJECTIVE: To identify factors associated with the ABCDEF bundle (Assess, prevent, and manage pain, Both, spontaneous awakening and breathing trials, Choice of sedation/analgesia, Delirium assess, prevent and manage, Early mobility/exercise and Family engagement/empowerment) adherence, in critically illpatients during the first 96 hours of mechanical ventilation. DESIGN: Observational study using electronic health record data. SETTING: 15 intensive care units located in seven community hospitals in a western United States health system. PATIENTS: 977 adult patients who were on mechanical ventilation for greater than 24 hours and admitted to an intensive care unit over six months. MEASUREMENTS AND MAIN RESULTS: Multiple regression analysis was used to examine factors contributing to bundle adherence while adjusting for severity of illness, days on mechanical ventilation, hospital site and time elapsed. ABCDEF bundle adherence was higher in patients on mechanical ventilation for less than 48 hours (p = 0.01), who received continuous sedation for less than 24 hours (p < 0.001), admitted from skilled nursing facilities (p < 0.05), and over the course of the six-month study period (p < 0.01). Bundle adherence was significantly lower for Hispanic patients (p < 0.01). CONCLUSIONS: Our study identified potentially modifiable factors that could improve the team's performance of the ABCDEF bundle in patients requiring mechanical ventilation.
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Authors: Brenda T Pun; Michele C Balas; Mary Ann Barnes-Daly; Jennifer L Thompson; J Matthew Aldrich; Juliana Barr; Diane Byrum; Shannon S Carson; John W Devlin; Heidi J Engel; Cheryl L Esbrook; Ken D Hargett; Lori Harmon; Christina Hielsberg; James C Jackson; Tamra L Kelly; Vishakha Kumar; Lawson Millner; Alexandra Morse; Christiane S Perme; Patricia J Posa; Kathleen A Puntillo; William D Schweickert; Joanna L Stollings; Alai Tan; Lucy D'Agostino McGowan; E Wesley Ely Journal: Crit Care Med Date: 2019-01 Impact factor: 7.598