University of Michigan, School of Nursing, Ann Arbor, MI, United States; University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, United States.
University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, United States; University of Michigan Medical School, Division of Pulmonary and Critical Care Medicine, Ann Arbor, MI, United States.
J Crit Care. 2018 Apr;44:1-6. doi: 10.1016/j.jcrc.2017.09.180. Epub 2017 Sep 28.
Awakening, Breathing Coordination, Delirium, and Early Mobility bundle (ABCDE) should involve an interprofessional team, yet no studies describe what team composition supports implementation.
MATERIALS & METHODS: We administered a survey at MHA Keystone Center ICU 2015 workshop. We measured team composition by the frequency of nurse, respiratory therapist, physician, physical therapist, nurse practitioner/physician assistant or nursing assistant involvement in 1) spontaneous awakening trials (SATs), 2) spontaneous breathing trials, 3) delirium and 4) early mobility. We assessed ABCDE implementation using a 5-point Likert ("routine part of every patient's care" - "no plans to implement"). We used ordinal logistic regression to examine team composition and ABCDE implementation, adjusting for confounders and clustering.
From 293 surveys (75% response rate), we found that frequent nurse [OR 6.1 (1.1-34.9)] and physician involvement [OR 4.2 (1.3-13.4)] in SATs, nurse [OR 4.7 (1.6-13.4)] and nursing assistant's involvement [OR 3.9 (1.2-13.5)] in delirium and nurse [OR 2.8 (1.2-6.7)], physician [OR (3.6 (1.2-10.3)], and nursing assistants' involvement [OR 2.3 (1.1-4.8)] in early mobility were significantly associated with higher odds of routine ABCDE implementation.
ABCDE implementation was associated with frequent involvement of team members, suggesting a need for role articulation and coordination.
觉醒、呼吸协调、谵妄和早期活动捆绑（ABCDE）应涉及一个多专业团队，但尚无研究描述支持实施的团队构成。
我们在 MHA Keystone 中心 ICU2015 研讨会上进行了一项调查。我们通过护士、呼吸治疗师、医生、物理治疗师、护士执业医师/医师助理或护理助理参与 1）自主唤醒试验（SATs）、2）自主呼吸试验、3）谵妄和 4）早期活动的频率来衡量团队构成。我们使用 5 点 Likert 量表（“每位患者护理的常规部分”-“无实施计划”）评估 ABCDE 的实施情况。我们使用有序逻辑回归来检查团队构成和 ABCDE 的实施情况，同时调整混杂因素和聚类。
在 293 份调查中（75%的回复率），我们发现 SATs 中护士[OR6.1（1.1-34.9）]和医生的频繁参与、护士[OR4.7（1.6-13.4）]和护理助理的频繁参与与谵妄有关，而护士[OR3.9（1.2-13.5）]、护理助理[OR2.8（1.2-6.7）]、医生[OR3.6（1.2-10.3）]和护理助理[OR2.3（1.1-4.8）]在早期活动中与常规 ABCDE 实施的可能性显著相关。
ABCDE 的实施与团队成员的频繁参与相关，这表明需要明确和协调角色。
