ABCDE Bundle in a Medical Intensive Care Unit:
The ABCDE bundle is an important element in the modern critical care setting or a medical intensive care unit. This bundle is a collaborated initiative between several disciplines for the management of patients who are critically ill. The usage of the ABCDE bundle is usually geared towards lessening immobility, oversedation, and the development of delirium, which combine to harm critically ill patients. Notably, the use of this bundle in the intensive care unit requires an understanding the meaning of each of the letters in the bundle in relation to patient care. In addition, the effectiveness of its use requires collaborative initiatives by respiratory therapists, physicians, and other health care professionals.
This bundle involves awakening trials for ventilated patients, which is signified by letter A, spontaneous breathing trials or B, and coordinated efforts between various stakeholders in the care process or C. These coordinated efforts should occur between registered nurses and respiratory therapists for the purpose of carrying out spontaneous breathing trial once the patient is awakened through preventing or reducing his/her sedation. During this process, these professionals review the utilized combination of sedation and analgesics as well as considering changes or reduction in the doses. Letter D. In this bundle refers to a standardized delirium assessment program that incorporates treatment and prevention options (McGann, 2012). The final letter in the bundle i.e. E refers to early mobilization and ambulation of patients in intensive or critical care setting.
Generally, ABCDE bundle in a medical intensive care unit is a defined and coordinated bundle that promote collaboration between physicians, registered nurses, physical therapists, and respiratory therapists in order to patient outcomes through lessening ICU-related complications. These professionals need to work together in enhancing patient outcomes because ventilator weaning takes place faster given that critical care patients are less likely to be oversedated, which decreases total ventilator days and the associated complications. The usage of ABCDE bundle requires coordinated efforts because of the need to reduce delirium, which tends to last for as long as a year after discharge from a health care facility. Delirium can also be decreased through identifying patients who develop the condition and aggressively managing it with changes in medication and patient care planning.
Regardless of the significance and benefit of usage of the ABCDE bundle in a medical intensive care unit, most medical staffs are seemingly reluctant to implement this protocol, particularly with very critical patients. However, the bundle has developed to become part of standard daily care in intensive care unit because all patients in these settings are considered eligible for the bundle. As a result of its clinical benefits, patients and families have reacted positively and enthusiastically to getting out of bed and staying awake to an extent that they think it is an ordinary procedure of their care. Even though ABCDE bundle has become part of standard daily care in ICU, hospital staffs have raised concern that its use contribute to the probability of self-extubation of ambulating and awake patients. Nonetheless, there have been incidents or reports of adverse outcomes with patients ambulating and being awake.
Notably, the use of this protocol in a clinical intensive care unit incorporates the best available evidence linked to ventilator management, immobility, delirium, and sedation/analgesia for implementation in daily clinical practice (Balas et. al., 2012, p.35). The ABCDE bundle is basically depends upon three major principles, which act as the foundation for its adoption in daily clinical practice in ICU. These principles are enhancing communication between members of the ICU team, standardizing the procedures of care, and stopping the cycle of oversedation and protracted mechanical ventilation that eventually results in weakness and delirium.
Balas et. al. (2012, April). Critical Care Nurses’ Role in Implementing the “ABCDE Bundle”
Into Practice. Critical Care Nurse, 32(2), 35-47. Retrieved June 21, 2014, from http://www.aacn.org/wd/Cetests/media/C1223.pdf
McGann, E. (2012, June 14). ABCDE Bundle: Improving Outcomes for Ventilated Patients.
Retrieved June 21, 2014, from http://www.medscape.com/viewarticle/765687
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