Background
Improved outcomes are associated with the Awakening, Breathing Coordination, Delirium and Early mobility/exercise (ABCDE) bundle; however, implementation issues are common. As yet, no study has integrated the barriers to ABCDE to provide an overview of reasons for less successful efforts. The purpose of this review was to identify and catalog the barriers to ABCDE delivery based on a widely used implementation framework, and provide a resource to guide clinicians in overcoming barriers to implementation.
Methods
We searched MEDLINE via PubMed, CINAHL, and Scopus for original research from January 1, 2007 to August 31, 2016 that identified barriers to ABCDE implementation for adult intensive care unit (ICU) patients. Two reviewers independently reviewed studies, extracted barriers and conducted thematic content analysis of the barriers, guided by the Consolidated Framework for Implementation Research. Discrepancies were discussed and consensus achieved.
Results
Our electronic search yielded 1908 articles. After applying our inclusion/exclusion criteria, we included 49 studies. We conducted thematic content analysis of the 107 barriers and identified 4 classes of ABCDE barriers: 1) patient-related (i.e. patient instability and safety concerns); 2) clinician-related (i.e. lack of knowledge, staff safety concerns); 3) protocol-related (i.e. unclear protocol criteria, cumbersome protocols to use); and—not previously identified in past reviews—4) ICU contextual barriers (i.e. interprofessional team care coordination).
Conclusions
We provide the first systematic differential diagnosis of barriers to ABCDE delivery, moving beyond the conventional focus on patient-level factors. Our analysis offers a differential diagnosis checklist for clinicians planning ABCDE implementation to improve patient care and outcomes.from #AlexandrosSfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2qapgG9
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