{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T07:22:49Z","timestamp":1789024969284,"version":"build-2803163510"},"reference-count":19,"publisher":"AACN Publishing","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,8,1]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The Society of Critical Care Medicine has established guidelines to manage pain, sedation, delirium, immobility, family participation, and sleep disruption in the intensive care unit, a set of interventions known as the intensive care unit liberation (ABCDEF) bundle. Adherence to these guidelines has shown positive results.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Local Problem<\/jats:title>\n                  <jats:p>In the intensive care units of a level I trauma academic teaching hospital in central Texas, the rate of bedside nursing staff adherence to the ABCDEF bundle was only 67.1% in January 2022. The aim of this quality improvement project was to improve adherence to the bundle.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Knowledge gaps were found to be the driver of the low adherence rate. Two primary needs were identified: (1) education on the elements of the ABCDEF bundle and (2) increased awareness and recognition of incomplete and incorrect documentation. Interventions included focused education on intensive care unit liberation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>From February to June 2022, overall adherence to the ABCDEF bundle increased from 67.1% to 95.3%, ventilator use decreased by approximately 10%, and restraint use dropped by about 9%. The incidence of delirium increased, but this increase was due to incorrect patient assessment before the interventions.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>The results of this project are consistent with literature demonstrating that a multifaceted approach to improving ABCDEF bundle adherence can produce sustainable improvement in patient outcomes. This report may help other organizations facing similar challenges improve adherence to the bundle in a postpandemic environment.<\/jats:p>\n               <\/jats:sec>","DOI":"10.4037\/ccn2024629","type":"journal-article","created":{"date-parts":[[2024,8,1]],"date-time":"2024-08-01T00:04:13Z","timestamp":1722470653000},"page":"19-26","source":"Crossref","is-referenced-by-count":3,"title":["Reigniting Intensive Care Unit Liberation"],"prefix":"10.4037","volume":"44","author":[{"given":"Margaret","family":"Guest","sequence":"first","affiliation":[{"name":"Margaret Guest is a charge nurse in the surgical trauma intensive care unit at Baylor Scott & White Medical Center-Temple, Texas."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Craven","sequence":"additional","affiliation":[{"name":"Kevin Craven is Director of Nursing for Critical Care at Baylor Scott & White Medical Center-Temple and a DNP student at Baylor University in Waco, Texas."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alaina M.","family":"Tellson","sequence":"additional","affiliation":[{"name":"Alaina M. Tellson is System Director for Nursing Research and the Transition to Practice program at Baylor Scott & White Health, Dallas, Texas."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marlene","family":"Porter","sequence":"additional","affiliation":[{"name":"Marlene Porter is a nurse-scientist at Baylor Scott & White Medical Center-Temple."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nakeitha","family":"James","sequence":"additional","affiliation":[{"name":"Nakeitha James is a nurse manager of the medical and neurologic intensive care units, Baylor Scott & White Medical Center-Temple."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Turley","sequence":"additional","affiliation":[{"name":"Lisa Turley is Manager of the surgical trauma intensive care unit at Baylor Scott & White Medical Center-Temple."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy","family":"Smitherman","sequence":"additional","affiliation":[{"name":"Jeremy Smitherman is Regional Director for Pulmonary\/ECMO Services at Baylor Scott & White Medical Center-Temple and a member of the Baylor Scott & White System Cardiopulmonary Council."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2471","reference":[{"key":"2024080100022765700_b1-0440019","unstructured":"Society of Critical Care Medicine\n          . Critical care statistics. Accessed August 7, 2023. https:\/\/www.sccm.org\/Communications\/Critical-Care-Statistics"},{"key":"2024080100022765700_b2-0440019","volume-title":"AACN Essentials of Critical Care Nursing","author":"Delgado","year":"2023","edition":"5th"},{"key":"2024080100022765700_b3-0440019","unstructured":"National Healthcare Safety Network\n          . Ventilator-associated event (VAE). Accessed August 7, 2023. https:\/\/www.cdc.gov\/nhsn\/pdfs\/pscmanual\/10-vae_final.pdf"},{"issue":"5","key":"2024080100022765700_b4-0440019","doi-asserted-by":"publisher","first-page":"653","DOI":"10.1111\/nicc.12857","article-title":"Incidence, prevalence and risk factors of delirium in ICU patients: a systematic review and meta-analysis","volume":"28","author":"Wu","year":"2023","journal-title":"Nurs Crit Care"},{"key":"2024080100022765700_b5-0440019","unstructured":"Society of Critical Care Medicine\n          . Choosing wisely in critical care: ten things clinicians and patients should question. Accessed August 7, 2023. https:\/\/www.sccm.org\/Clinical-resources\/choosing-wisely-in-critical-care"},{"issue":"1","key":"2024080100022765700_b6-0440019","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1097\/CCM.0b013e3182783b72","article-title":"Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit","volume":"41","author":"Barr","year":"2013","journal-title":"Crit Care Med"},{"issue":"3","key":"2024080100022765700_b7-0440019","doi-asserted-by":"publisher","first-page":"472","DOI":"10.1097\/CCM.0000000000004876","article-title":"Choosing wisely for critical care: the next five","volume":"49","author":"Zimmerman","year":"2021","journal-title":"Crit Care Med"},{"issue":"1","key":"2024080100022765700_b8-0440019","doi-asserted-by":"publisher","first-page":"46","DOI":"10.4037\/ccn2019927","article-title":"Common challenges to effective ABC-DEF bundle implementation: the ICU Liberation Campaign experience","volume":"39","author":"Balas","year":"2019","journal-title":"Crit Care Nurse"},{"issue":"4","key":"2024080100022765700_b9-0440019","doi-asserted-by":"publisher","first-page":"562","DOI":"10.1097\/CCM.0000000000004197","article-title":"Best practices for conducting interprofessional team rounds to facilitate performance of the ICU liberation (ABCDEF) bundle","volume":"48","author":"Stollings","year":"2020","journal-title":"Crit Care Med"},{"issue":"4","key":"2024080100022765700_b10-0440019","doi-asserted-by":"publisher","first-page":"1326","DOI":"10.1016\/j.chest.2021.06.002","article-title":"How we prevent and treat delirium in the ICU","volume":"160","author":"Palakshappa","year":"2021","journal-title":"Chest"},{"issue":"2","key":"2024080100022765700_b11-0440019","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1097\/CNQ.0000000000000448","article-title":"A multidisciplinary approach to increase compliance with spontaneous awakening trials and spontaneous breathing trials in the medical intensive care unit","volume":"46","author":"Jones","year":"2023","journal-title":"Crit Care Nurs Q"},{"issue":"1","key":"2024080100022765700_b12-0440019","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.cnc.2020.10.001","article-title":"Intensive care unit nursing priorities in the United States","volume":"33","author":"Alexander","year":"2021","journal-title":"Crit Care Nurs Clin North Am"},{"issue":"2","key":"2024080100022765700_b13-0440019","doi-asserted-by":"publisher","first-page":"92","DOI":"10.4037\/ajcc2023755","article-title":"Measuring performance on the ABCDEF bundle during interprofessional rounds via a nurse-based assessment tool","volume":"32","author":"King","year":"2023","journal-title":"Am J Crit Care"},{"issue":"6","key":"2024080100022765700_b14-0440019","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1097\/JTN.0000000000000405","article-title":"Impacting delirium in the trauma ICU utilizing the ICU Liberation Collaborative Benchmark Report","volume":"25","author":"Sweeney","year":"2018","journal-title":"J Trauma Nurs"},{"issue":"3","key":"2024080100022765700_b15-0440019","doi-asserted-by":"publisher","first-page":"e0872","DOI":"10.1097\/CCE.0000000000000872","article-title":"An exploration of critical care professionals\u2019 strategies to enhance daily implementation of the Assess, prevent, and manage pain; Both spontaneous awakening and breathing trials; Choice of analgesia and sedation; Delirium assess, prevent, and manage; Early mobility and exercise; and Family engagement and empowerment: a group concept mapping study","volume":"5","author":"Mion","year":"2023","journal-title":"Crit Care Explor"},{"key":"2024080100022765700_b16-0440019","unstructured":"American Society for Quality (ASQ)\n          . What is the plan-do-check-act (PDCA) cycle?\u2008Accessed August 8, 2023. https:\/\/asq.org\/quality-resources\/pdca-cycle"},{"issue":"2","key":"2024080100022765700_b17-0440019","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1097\/NCQ.0000000000000678","article-title":"The Johns Hopkins Activity and Mobility Promotion Program: a framework to increase activity and mobility among hospitalized patients","volume":"38","author":"McLaughlin","year":"2023","journal-title":"J Nurs Care Qual"},{"issue":"5","key":"2024080100022765700_b18-0440019","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1080\/20009666.2020.1801373","article-title":"A novel early mobility bundle improves length of stay and rates of readmission among hospitalized general medicine patients","volume":"10","author":"Bergbower","year":"2020","journal-title":"J Community Hosp Intern Med Perspect"},{"key":"2024080100022765700_b19-0440019","doi-asserted-by":"publisher","first-page":"104410","DOI":"10.1016\/j.ijnurstu.2022.104410","article-title":"The effect of the ABCDE\/ABCDEF bundle on delirium, functional outcomes, and quality of life in critically ill patients: a systematic review and meta-analysis","volume":"138","author":"Sosnowski","year":"2023","journal-title":"Int J Nurs Stud"}],"container-title":["Critical Care Nurse"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/aacnjournals.org\/ccnonline\/article-pdf\/44\/4\/19\/158367\/19.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/aacnjournals.org\/ccnonline\/article-pdf\/44\/4\/19\/158367\/19.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,1]],"date-time":"2024-08-01T00:04:27Z","timestamp":1722470667000},"score":1,"resource":{"primary":{"URL":"https:\/\/aacnjournals.org\/ccnonline\/article\/44\/4\/19\/32517\/Reigniting-Intensive-Care-Unit-Liberation"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,1]]},"references-count":19,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2024,8,1]]}},"URL":"https:\/\/doi.org\/10.4037\/ccn2024629","relation":{},"ISSN":["0279-5442","1940-8250"],"issn-type":[{"value":"0279-5442","type":"print"},{"value":"1940-8250","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,1]]}}}