ABCDEF Bundle Implementation

Transcription

1 ABCDEF Bundle Implementation Anne Putzer, MS, RN, ACNS-BC, CCRN Cat Zyniecki, BSN, RN, CCRN Columbia St. Mary s Wisconsin Association of Clinical Nurse Specialists CNO/CNS/Shared Governance Breakfast September 11, 2015

2 Background and Significance ~To Nursing and Shared Governance~ Prolonged ventilation and over-sedation can lead to negative consequences for patients and families Pain, Agitation, & Delirium Guidelines ICU Liberation ABCDEF Bundle Implementation Collaborative ABCDEF Bundle Assess for and manage pain Both Spontaneous Awakening Trials (SAT) & Spontaneous Breathing Trials (SBT) Choice of sedation and analgesia Delirium monitoring and management Early mobility Family engagement Goal Improved Patient Outcomes

3 Project Overview Purpose of the project: Hardwire bundle compliance and interprofessional collaboration Change the current culture of ventilator weaning Establish and sustain systematic processes that lead to optimal patient outcomes Framework: Kurt Lewin s Change Theory - Unfreezing, change, & refreezing Population: Interprofessional critical care team including RN s, Physical Therapists, Respiratory Therapists, Pharmacists, and Physicians Setting: Two hospital system with 2 Critical Care Units, 1 Progressive Care Unit, and 1 ICU/Acuity Adaptable Unit Method / Design & Procedure: VARK (Visual, Aural, Read/Write, and Kinesthetic) learning strategy

4 Project Description Creation of Interprofessional team Critical Care Skills Fair Overview of the revised bundle CAM (Confusion Assessment Method)-ICU competency assessment Pocket cards CPOT Educational Module CNS and champion bedside support In-person educational kick-off sessions for Interprofessional team (RN-RT-PT) with ABCDEF Bundle video Redesign of Ventilator Weaning Protocol Revision of Ventilator Bundle orders in progress Provider education Monitoring of bundle compliance

5 Project Results Critical Care Skills Fair - CAM-ICU competency assessed Multiple kick-off teaching sessions held CPOT training - in progress Bundle Compliance Data Unit & Staff Level Surveys Long Term Outcome Measurements ICU LOS Hospital LOS Delirium Days Mortality HAPU rate Re-intubations Activity level at discharge VAP rates

6 Implications for Nursing Practice Establishing consistent practices and bundle compliance will ultimately lead to improved patient outcomes Improved teamwork and collaboration RN coordinates Inclusion of family members as part of the team Barrier sustaining/hardwiring Continued CNS support for staff after implementation Patient/Family and Nursing Spheres of Influence Barrier - seems overwhelming One patient at a time power of one Nurses as change agents Not just another task to do related to overall picture of patient safety & quality

7 References Balas, M. C., Vasilevskis, E. E., Olsen, K. M., Schmid, K. K., Shostrom, V., Cohen, M. Z., Burke, W. J. (2014). Effectiveness and safety of the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility bundle, Critical Care Medicine, 42(5), Barr, J., Fraser, G. L., Puntillo, K., Ely, E. W., Gelinas, C., Dasta, J. F.,...Jaeschke, R. (2013). Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit, Critical Care Medicine, 41, Kitchie, S. (2008). Applying Learning Theory to Healthcare Practice. In Bastable, S. B. (3 rd Edition) Nurse as educator: Principles of teaching and learning for nursing practice, (pp ). Massachusetts: Jones and Bartlett. Kritsonis, A. (2011). Comparison of change. International Journal of Scholarly Academic Intellectual Diversity, 8(1),

8 Contact Information Anne Putzer, MS, RN, ACNS-BC, CCRN Clinical Nurse Specialist Cat Zyniecki, BSN, RN, CCRN Clinical Nurse III & CNS Student