The ABCDE bundle implementation in an intensive care unit: Facilitators and barriers perceived by nurses and doctors.

Aim: To describe the facilitators and barriers perceived by healthcare teams after the implementation of the Awakening, Breathing, Coordination, Delirium monitoring/management and Early mobility bundle in an intensive care unit in Italy. This multicomponent intervention strategy has been associated with lower probabilities of delirium, improved functional outcomes and shorter duration of mechanical ventilation. Methods: A survey study conducted between June 2015 and May 2016 explored variables related to intensive care unit team members: perceptions of delirium; knowledge of the Awakening, Breathing, Coordination, Delirium monitoring/management and Early mobility bundle; teamwork perception and resource availability. Results: Most of the participants affirmed having reasonable knowledge of delirium, outcomes of delirious episodes, Awakening, Breathing, Coordination, Delirium monitoring/management and Early mobility bundle components and their effectiveness. Low coordination between healthcare professionals was identified as a barrier. Overall, the time elapsing from the beginning of implementation of the bundle determined an increase in levels of awareness and confidence in the application of the bundle protocol and the Confusion Assessment Method Intensive Care Unit scale. Conclusion: Issues with the Awakening, Breathing, Coordination, Delirium monitoring/management and Early mobility bundle relating to coordination, management and interdisciplinary ward rounds are critical and should be remedied and monitored. This study could provide the basis for improving bundle implementation strategies and surveying levels of progression in other intensive care units. Summary statements: What is already known about this topic? Many patients admitted to intensive care units acquire iatrogenic comorbidities. These conditions can complicate their recovery from critical illness and negatively affect their post‐discharge quality of life.The ABCDE bundle is an evidence‐based approach that can help to reduce the negative consequences of an intensive care unit stay.No literature describes health professionals' experiences of implementation of the whole ABCDE bundle in a European country. What this paper adds? The experiences of the ABCDE bundle implementation could provide a basis for the improvement of these strategies in other countries.The time elapsing from the beginning of implementation of the ABCDE bundle determines an increase in levels of awareness and confidence in the application of the ABCDE bundle protocol itself, and the CAM‐ICU scale. The implications of this paper: The implementation of the ABCDE bundle is feasible and may be perceived as necessary because of professionals' high awareness of the patient complications resulting from bed rest, delirium and prolonged mechanical ventilation.Issues with the ABCDE bundle relating to coordination, management and interdisciplinary ward rounds are critical and should be remedied and monitored.A longitudinal study could improve understanding of the long‐time effects of the bundle on patients' outcome. [ABSTRACT FROM AUTHOR]