The institution's Chief Nursing Officer (CNO) was the first administrator that was contacted regarding the possibility of implementing the ABCDE bundle into everyday care, followed by the Critical Care Medical Director. Incorporating the Medical Directors' feedback, the research team developed the initial implementation plan. This interprofessional team met on numerous occasions to discuss: how key stakeholders may perceive the bundle, educational strategies (e.g. computer based, in person, etc.), marketing strategies (e.g. with graphics, pocket cards, etc.), evaluation strategies, methods of outcomes assessment, and communication strategies. The research team then collaborated with hospital administrators to identify and formally appoint interdisciplinary (i.e., nursing, PT, RT, pharmacy, and physicians trained in various specialties) ABCDE bundle implementation leaders. While numerous implementation leaders were identified, the most active members included the ICU nursing director, a lead RT, one medical and one surgical CCS physician, an ICU-based PT, 2 pharmacists, 2 assistant nurse managers, and a neurosurgeon with extensive ICU experience.
All implementation leaders received a file that described the bundle and supporting studies. We also provided the proposed delirium and sedation/agitation screening tools and resources. The implementation leaders were expected to become familiar with the ABCDE bundle prior to the initial group meeting. At this meeting, the research team and implementation leaders discussed the ABCDE bundle and attempted to identify existing institutional policies related to sedation/analgesia, alcohol withdrawal, ventilator management, and mobility that would support or conflict with the ABCDE bundle. At subsequent meetings, the group discussed the bundles' evidence strength and quality, the relative advantages and disadvantages of change, perceived ABCDE bundle complexity/quality, and potential costs and barriers associated with bundle implementation.
Next we identified unit-level leaders. This group included ICU nurse managers, CCS NPs/PAs, nurse educators, the director of respiratory care, an additional ICU pharmacist, other CCS physicians, and members of the performance improvement team. Numerous meetings discussed the same topics as those held with the formal implementation leaders. Each of the unit-level leaders was then asked to identify staff that they thought may be willing to serve as ABCDE bundle champions. The research team then incorporated staff feedback and began the process of developing, obtaining, and distributing educational resources. These resources included a number of different informational posters/flyers, unit-level ABCDE bundle resource manuals, unit and specialty based in-services, and CAM-ICU and RASS pocket cards.
All implementation leaders received a file that described the bundle and supporting studies. We also provided the proposed delirium and sedation/agitation screening tools and resources. The implementation leaders were expected to become familiar with the ABCDE bundle prior to the initial group meeting. At this meeting, the research team and implementation leaders discussed the ABCDE bundle and attempted to identify existing institutional policies related to sedation/analgesia, alcohol withdrawal, ventilator management, and mobility that would support or conflict with the ABCDE bundle. At subsequent meetings, the group discussed the bundles' evidence strength and quality, the relative advantages and disadvantages of change, perceived ABCDE bundle complexity/quality, and potential costs and barriers associated with bundle implementation.
Next we identified unit-level leaders. This group included ICU nurse managers, CCS NPs/PAs, nurse educators, the director of respiratory care, an additional ICU pharmacist, other CCS physicians, and members of the performance improvement team. Numerous meetings discussed the same topics as those held with the formal implementation leaders. Each of the unit-level leaders was then asked to identify staff that they thought may be willing to serve as ABCDE bundle champions. The research team then incorporated staff feedback and began the process of developing, obtaining, and distributing educational resources. These resources included a number of different informational posters/flyers, unit-level ABCDE bundle resource manuals, unit and specialty based in-services, and CAM-ICU and RASS pocket cards.
