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Assessment of the impact of an integrated interprofessional working group to promote the ICU Liberation initiatives -Our story two years on
Journal of the Intensive Care Society ; 23(1):164-165, 2022.
Article in English | EMBASE | ID: covidwho-2043004
ABSTRACT

Introduction:

Pain, agitation, delirium, weakness, and sleep deprivation are well recognized symptoms during an ICU stay.1 In 2019, our institution set up an ICU Liberation Working Group (ILWG)2, aiming to reduce the harmful effects of these symptoms. This interprofessional working group encompassed medical, pharmacy, nursing and allied health members and utilised a multifocal approach.

Objectives:

To review the impact of various initiatives implemented on the outcomes of the ABCDEF (A2F) bundle in the last two years.

Methods:

These initiatives are based on each aspect of the A2F bundle. As shown in Table 1, the interventions were each targeted to one aspect of the A2F bundle and were grouped under four themes of teaching, operational interventions, informatics, and guidelines/policies. These interventions were audited regularly, with the results displayed on awareness boards, aiming to encourage staff engagement. An ICU Liberation week was also held to improve awareness and compliance with the A2F bundle.

Results:

Audit cycles were performed in April 2019, December 2019, and November 2020, assessing data representing each arm of the A2F bundle. Two-thirds of the audit standards showed a significant improvement after initial interventions were employed. The third cycle showed improvement has been maintained in half of the standards. Unfortunately, adherence did reduce in several fields. The greatest improvement was seen in sedation target documentation. A further cycle in January 2021 assessed the impact of COVID-19 on A2F application, showing a reduction across most audit criteria. There were, however, improvements in family updates and early mobilisation.

Conclusion:

The ongoing work of an interprofessional ILWG has shown a cohesive approach application of the A2F bundle, which has resulted in improved harm prevention and management. The impact of COVID-19 has been shown to have reduced our ability to provide improvements in A2F application. Ongoing interventions are a bespoke sleep tool and more detailed CAM-ICU assessment, designed to elucidate the underlying causes of sleep disruption and delirium. A focused quality improvement project has started, where specific interventions are to be trialed on one ICU before expectant deployment throughout other ICUs. Data will continue to be collected and presented to further assess the most effective methodology for application of the A2F bundle.
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Full text: Available Collection: Databases of international organizations Database: EMBASE Type of study: Experimental Studies Language: English Journal: Journal of the Intensive Care Society Year: 2022 Document Type: Article

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Full text: Available Collection: Databases of international organizations Database: EMBASE Type of study: Experimental Studies Language: English Journal: Journal of the Intensive Care Society Year: 2022 Document Type: Article