Perceptions of Workload Burden and Adherence to ABCDE Bundle Among Intensive Care Providers.
Leanne M Boehm, Mary S Dietrich, Eduard E Vasilevskis and 4 others
PMID 28668925WHAT IT FOUND
Units whose providers reported more workload burden were less likely to complete the ABCDE bundle.
Units whose providers found it harder to carry out were less likely to do early mobility. Attitudes about safety, confidence and evidence were not linked.
Key findings
01For every unit increase in perceived workload burden, overall ABCDE bundle adherence was 53% less likely.
02For every unit increase in perceived difficulty carrying out the bundle, early mobility adherence was 59% less likely.
03Overall ABCDE bundle adherence was 72% on ventilator days and 97% on ventilator-free days.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
Only 25% of ICU professionals responded, and 106 surveys were excluded for lacking attitude data, so the attitude estimates may not represent all staff. Provider attitudes were aggregated by unit, so the study cannot show that one provider's attitude caused missed bundle components. Adherence was likely overestimated because providers were encouraged to complete components daily, and data were not collected on every ICU patient. The patient sample was 101, and some components had too few nonadherent cases for odds ratios, limiting findings for awakening, breathing and delirium components. The safety and confidence subscales had low internal consistency, so null findings for those attitudes may reflect measurement problems.
Declared interests
The study was funded by the American Association of Critical-Care Nurses and Sigma Theta Tau International Critical Care Grant. No other conflict of interest statement is provided in the supplied text.
The easy way to misread this
Do not conclude that reducing workload or simplifying the bundle will improve adherence. The study only observed associations between provider attitudes and adherence, and it did not test any intervention.