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

International Journal of Nursing Studies

Sosnowski, K., Lin, F., et al. (2023).

International Journal of Nursing Studies, 138, 104410.

<div>This systematic review and meta-analysis investigates the impact of the ABCDEF bundle (<strong>A</strong>ssess, prevent, and manage pain;&nbsp;<strong>B</strong>oth spontaneous awakening and spontaneous breathing trials;&nbsp;<strong>C</strong>hoice of analgesia and sedation;&nbsp;<strong>D</strong>elirium: assess, prevent, and manage;&nbsp;<strong>E</strong>arly mobility and exercises;&nbsp;<strong>F</strong>amily engagement and empowerment) on delirium, function, and quality of life (QoL) in adults in the intensive care unit (ICU).&nbsp;</div>

No funding received

From database inception to January 2022

<div>Published quantitative and qualitative studies&nbsp;</div>

18

<div>When compared with standard practice, ABCDEF bundles had the following effects for adults in the ICU:</div> <div> <ul> <li>decreased delirium incidence (risk ratio = 0.57);</li> <li>reduced duration of ICU delirium (mean difference = -1.37 days);&nbsp;</li> <li>mixed effects (i.e., positive and neutral findings) on physical function; and</li> <li>improved QoL scores in one study.&nbsp;</li> </ul> <div>Limitations to this review include significant heterogeneity between studies, potential issues with internal validity within studies, the inclusion of studies that have not been peer-reviewed, and potential publication bias. Additional, high quality research is indicated.&nbsp;</div> </div>

<div>Facilitators to implementing the ABCDEF bundles within adult ICUs included the presence of:&nbsp;</div> <div> <ul> <li>family engagement/involvement;</li> <li>clinician collaboration within an interdisciplinary team (IDT);</li> <li>clinician expertise within the IDT;</li> <li>a dedicated ABCDEF IDT to champion bundle compliance;</li> <li>unit champions to support education, serve as a resource, and assist in overcoming barriers to implementation;</li> <li>simulation training and skill development;</li> <li>IDT collaboration, practice, shared decision making, and multimodal education;</li> <li>discussion of bundle during IDT rounds;</li> <li>nurse or physician-led implementation;</li> <li>introduction of early mobilization within 24 hours of admission;</li> <li>adjustment of existing policies/procedures and organization support for these changes;</li> <li>a non-pharmacological treatment focus;</li> <li>encouragement of bed-side nurses to engage in IDT rounds;</li> <li>dedicated rehabilitation staff;</li> <li>organizational support from key stakeholders;</li> <li>clinical information systems; and&nbsp;</li> <li>a dedicated physical therapist to foster collaboration and improve outcomes.&nbsp;</li> </ul> </div>

<div>Barriers to implementing the ABCDEF bundles within adult ICUs included the existence of:</div> <div> <ul> <li>clinicians' lack of knowledge, negative attitudes, or staff communication issues;</li> <li>a lack of equipment, times, staffing, or a dedicated physical therapist or IDT for mobilization;</li> <li>light and noise;</li> <li>patient medical issues (e.g., hemodynamic or respiratory instability);</li> <li>procedures or tests, including dialysis;</li> <li>patient fatigue, agitation, or delirium;</li> <li>deep sedation;</li> <li>a lack of prescribed glasses or hearing aids; and</li> <li>patient refusal.&nbsp;</li> </ul> </div>