• Michele C Balas, Alai Tan, Brenda T Pun, E Wesley Ely, Shannon S Carson, Lorraine Mion, Barnes-DalyMary AnnMAMary Ann Barnes-Daly is a clinical performance improvement consultant at Sutter Health, Sacramento California., and Eduard E Vasilevskis.
• Michele C. Balas is an associate dean of research and Dorothy Hodges Olsen Distinguished Professor of Nursing at the University of Nebraska Medical Center College of Nursing, Omaha, Nebraska.
• Am. J. Crit. Care. 2022 Jan 1; 31 (1): 546454-64.

BackgroundThe ABCDEF bundle (Assess, prevent, and manage pain and Delirium; Both spontaneous awakening and breathing trials; Choice of analgesia/sedation; Early mobility; and Family engagement) improves intensive care unit outcomes, but adoption into practice is poor.ObjectiveTo assess the effect of quality improvement collaborative participation on ABCDEF bundle performance.MethodsThis interrupted time series analysis included 20 months of bundle performance data from 15 226 adults admitted to 68 US intensive care units. Segmented regression models were used to quantify complete and individual bundle element performance changes over time and compare performance patterns before (6 months) and after (14 months) collaborative initiation.ResultsComplete bundle performance rates were very low at baseline (<4%) but increased to 12% by the end. Complete bundle performance increased by 2 percentage points (SE, 0.9; P = .06) immediately after collaborative initiation. Each subsequent month was associated with an increase of 0.6 percentage points (SE, 0.2; P = .04). Performance rates increased significantly immediately after initiation for pain assessment (7.6% [SE, 2.0%], P = .002), sedation assessment (9.1% [SE, 3.7%], P = .02), and family engagement (7.8% [SE, 3%], P = .02) and then increased monthly at the same speed as the trend in the baseline period. Performance rates were lowest for spontaneous awakening/breathing trials and early mobility.ConclusionsQuality improvement collaborative participation resulted in clinically meaningful, but small and variable, improvements in bundle performance. Opportunities remain to improve adoption of sedation, mechanical ventilation, and early mobility practices.©2022 American Association of Critical-Care Nurses.

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