Balas Michele C, Pun Brenda T, Pasero Chris, Engel Heidi J, Perme Christiane, Esbrook Cheryl L, Kelly Tamra, Hargett Ken D, Posa Patricia J, Barr Juliana, Devlin John W, Morse Alexandra, Barnes-Daly Mary Ann, Puntillo Kathleen A, Aldrich J Matthew, Schweickert William D, Harmon Lori, Byrum Diane G, Carson Shannon S, Ely E Wesley, Stollings Joanna L
Michele Balas is an associate professor, Center of Excellence in Critical and Complex Care, College of Nursing, and a nurse scientist, Wexner Medical Center, The Ohio State University, Columbus.
Chris Pasero is a pain management clinical consultant, El Dorado Hills, California.
Crit Care Nurse. 2019 Feb;39(1):46-60. doi: 10.4037/ccn2019927.
Although growing evidence supports the safety and effectiveness of the ABCDEF bundle (A, assess, prevent, and manage pain; B, both spontaneous awakening and spontaneous breathing trials; C, choice of analgesic and sedation; D, delirium: assess, prevent, and manage; E, early mobility and exercise; and F, family engagement and empowerment), intensive care unit providers often struggle with how to reliably and consistently incorporate this interprofessional, evidence-based intervention into everyday clinical practice. Recently, the Society of Critical Care Medicine completed the ICU Liberation ABCDEF Bundle Improvement Collaborative, a 20-month, nationwide, multicenter quality improvement initiative that formalized dissemination and implementation strategies and tracked key performance metrics to overcome barriers to ABCDEF bundle adoption. The purpose of this article is to discuss some of the most challenging implementation issues that Collaborative teams experienced, and to provide some practical advice from leading experts on ways to overcome these barriers.
尽管越来越多的证据支持ABCDEF集束化治疗（A，评估、预防和处理疼痛；B，自主唤醒和自主呼吸试验；C，镇痛和镇静的选择；D，谵妄：评估、预防和处理；E，早期活动与锻炼；F，家属参与和赋权）的安全性和有效性，但重症监护病房的医护人员常常难以确定如何将这种基于循证的多专业干预措施可靠且持续地纳入日常临床实践中。最近，危重病医学会完成了ICU解放ABCDEF集束化治疗改进协作项目，这是一项为期20个月的全国性多中心质量改进计划，该计划规范了传播和实施策略，并跟踪关键绩效指标，以克服采用ABCDEF集束化治疗的障碍。本文旨在讨论协作团队在实施过程中遇到的一些最具挑战性的问题，并提供来自顶尖专家的一些实用建议，以帮助克服这些障碍。
