The objectives of the ABCDEF bundle are to optimize pain management, break the cycle of deep sedation and prolonged mechanical ventilation, reduce the incidence and duration of delirium in the ICU setting, improve short- and long-term ICU patient outcomes, and reduce health care costs by reducing the average length of stay in the ICU and within the hospital.
A meta-analysis was taken of 21 studies, all including process measures and 9 specifically with clinical outcomes data.
ABCDEF Implementation Success: Meta-Analysis
SAY: A variety of programs have improved process measures using the ABCDEF bundle, such as achieving a 92 percent delirium screening adherence. Mobility has increased as well. When multidisciplinary teams engage patients in physical and occupational therapy, the results are more patients getting out of bed, sitting on the side of the bed, and even moving to sit in chairs.
As important as the ABCDEF bundle is, implementing structural and organizational changes that improve standard provider behaviors are vital to achieving higher success rates, ensuring compliance, and establishing long-term sustainable change. The Institute for Healthcare Improvement instructs in the Journal of Quality and Patient Safety that certain environment changes require human beings to modify their behavior. Human factors are such an important piece to achieving sustainable change. As a result, you should give feedback regularly, provide ongoing education, and build a strong will through seeing work in action with your staff.
According to statistics, using more than six implementation strategies and integrating either PAD guidelines or the ABCDEF bundle lowers mortality and shortens ICU length of stay. Delirium “incidence” remains static, and so delirium duration may be a better metric.