Bold Voices - August 2017 - 19

AT THE BEDSIDE

Bundle Compliance Increases
Survival, Reduces Delirium

I

ntensive care units that comply with a bundle of evidenced-based practices that
get patients moving can increase survival rates and reduce risks of delirium and
coma.
"Improving Hospital Survival and Reducing Brain Dysfunction at Seven
California Community Hospitals: Implementing PAD Guidelines Via the
ABCDEF Bundle in 6,064 Patients," in Critical Care Medicine, tracked how well
seven community hospitals in a California health system complied with the
Awakening and Breathing coordination, Choice of drugs, Delirium monitoring and management, Early mobility,
and Family engagement (ABCDEF) bundle, while implementing Pain, Agitation, and Delirium (PAD) guidelines.
The study involved 6,064 ventilated or nonventilated medical and surgical ICU patients in 2014. For every 10
percent increase in total bundle compliance, odds of hospital survival increased 7 percent. Each 10 percent increase
in partial compliance resulted in 15 percent higher odds of hospital survival. "Higher bundle compliance was
independently associated with improved survival and more days free of delirium and coma after adjusting for age,
severity of illness, and presence of mechanical ventilation," the study adds.
A related article in Marketplace notes that nurses and other healthcare professionals at Parkland Hospital in Dallas
participate in a national program called ICU Liberation. Team members closely monitor patients' medications to
reduce sedatives, and they keep patients moving.
Study co-author Wes Ely, professor of critical care at Vanderbilt University Medical Center in Nashville,
Tennessee, has studied ICU delirium for two decades, the article notes. He designed the program that Parkland and
many other hospitals are using.
"It dramatically reduces the amount of exposure that patients get to these dangerous drugs," Ely says in the
article. "It gets them out of the bed sooner - plus involving the family so patients get reoriented - and it makes a
massive difference to the patient."
REFERENCE: Barnes-Daly MA, Phillips G, Ely EW. Improving hospital survival and reducing brain dysfunction at seven California community hospitals: implementing PAD
guidelines via the ABCDEF bundle in 6,064 patients. Crit Care Med. 2017;45(2):171-178.

Reducing Risk Factors in Pediatric Delirium

D

elirium, which occurs frequently
in pediatric intensive care, is a
strong predictor of mortality,
but the potential exists to reduce
certain risk factors.
According to "Delirium and
Mortality in Critically Ill Children:
Epidemiology and Outcomes of
Pediatric Delirium," in Critical Care
Medicine, 17 percent of critically ill
children had delirium and were 4.39
times more likely to die, according to the results of a study in
an urban academic tertiary care pediatric ICU.
The prospective, longitudinal cohort study of 1,547
patients from 2014 to 2015 included twice-daily screenings
for delirium and sought to establish whether the condition
was an independent predictor of mortality, as it is with
adults.
Delirium developed within the first three days of ICU stay
in 78 percent of patients, and they had longer lengths of

Delirium
is a strong
independent
predictor of
mortality in
critically ill
children.

stay and longer mechanical ventilation. Among the 267 children diagnosed with delirium, the condition lasted a median
of two days, and most cases were hypoactive (46 percent) or
mixed (45 percent) subtypes.
Some of the independent predictors of pediatric delirium
that providers should consider include the following:
*
*
*
*
*
*

Age 2 or younger
Developmental delay
Illness severity
Previous coma
Mechanical ventilation
Receipt of benzodiazepines and anticholinergics

Some of the potential in-hospital risk factors for developing delirium are modifiable, but determining best practices
for limiting exposure in at-risk children requires interventional
research, the study adds.
REFERENCE: Traube C, Silver G, Gerber LM, et al. Delirium and mortality in critically
ill children: epidemiology and outcomes of pediatric delirium. Crit Care Med.
2017;45(5):891-898.

19
AACN BOLD VOICES AUGUST 2017

For every 10 percent increase
in total compliance, patients'
odds of hospital survival
increased 7 percent.


http://journals.lww.com/ccmjournal/Citation/2017/02000/Improving_Hospital_Survival_and_Reducing_Brain.4.aspx http://journals.lww.com/ccmjournal/Citation/2017/02000/Improving_Hospital_Survival_and_Reducing_Brain.4.aspx http://journals.lww.com/ccmjournal/Citation/2017/02000/Improving_Hospital_Survival_and_Reducing_Brain.4.aspx https://www.marketplace.org/2017/05/02/health-care/stopping-icu-delirium-getting-patients-moving http://www.iculiberation.org/Pages/default.aspx http://journals.lww.com/ccmjournal/Abstract/2017/05000/Delirium_and_Mortality_in_Critically_Ill_Children_.19.aspx http://journals.lww.com/ccmjournal/Abstract/2017/05000/Delirium_and_Mortality_in_Critically_Ill_Children_.19.aspx http://journals.lww.com/ccmjournal/Abstract/2017/05000/Delirium_and_Mortality_in_Critically_Ill_Children_.19.aspx http://journals.lww.com/ccmjournal/Abstract/2017/05000/Delirium_and_Mortality_in_Critically_Ill_Children_.19.aspx

Table of Contents for the Digital Edition of Bold Voices - August 2017

Another Angle
Pres Note Front Teaser
Masthead
New Online Toolkit Shows Crucial Roles of Nurses in Serious Illness Communication
Oct. 31 Deadline to Apply for AACN Research Grants
PCCN or CCRN: Which Certification Is Right for You?
Failed Resuscitations May Increase Stress for Nurses
Updated Cardiac Nursing Course and CMC Review Course Online
New Behavior-Based Pain Assessment Tool
Hospital Rooftop Is a Hive of Activity
Former ICU Nurse Collects 100K Objects for Medical Mosaic
Interventions Reduce Wrong-Patient Orders in NICUs
Increasing Acceptance of Pediatric Telemedicine
The Privilege of Nursing
Effects of Dexmedetomidine
Seizure Risk Much Higher for Sepsis Survivors
Studies Provide Insights Into Reducing Opioid Use
Short-Term Oral Corticosteroids Increase Risk of Adverse Effects
Hospital Staff Becoming Product Innovators
Addressing Barriers to APRN Practice
Survival Rates Higher During Joint Commission Surveys
Effect of Rudeness on Pediatric Team Performance
Glasgow Coma Scale Stands the Test of Time
ECRI Introduces Patient Identification Tools
Reducing Risk Factors in Pediatric Delirium
Bundle Compliance Increases Survival, Reduces Delirium
Fostering Resilience in Healthcare Professionals Who Are Also Moms
Members: Enhance Your Career With an AACN Scholarship
In Our Journals
Transitions
President’s Note
Bold Voices - August 2017 - Cover1
Bold Voices - August 2017 - Cover2
Bold Voices - August 2017 - Pres Note Front Teaser
Bold Voices - August 2017 - Masthead
Bold Voices - August 2017 - Oct. 31 Deadline to Apply for AACN Research Grants
Bold Voices - August 2017 - PCCN or CCRN: Which Certification Is Right for You?
Bold Voices - August 2017 - 7
Bold Voices - August 2017 - Updated Cardiac Nursing Course and CMC Review Course Online
Bold Voices - August 2017 - New Behavior-Based Pain Assessment Tool
Bold Voices - August 2017 - Former ICU Nurse Collects 100K Objects for Medical Mosaic
Bold Voices - August 2017 - Increasing Acceptance of Pediatric Telemedicine
Bold Voices - August 2017 - The Privilege of Nursing
Bold Voices - August 2017 - 13
Bold Voices - August 2017 - Seizure Risk Much Higher for Sepsis Survivors
Bold Voices - August 2017 - Short-Term Oral Corticosteroids Increase Risk of Adverse Effects
Bold Voices - August 2017 - Addressing Barriers to APRN Practice
Bold Voices - August 2017 - Effect of Rudeness on Pediatric Team Performance
Bold Voices - August 2017 - ECRI Introduces Patient Identification Tools
Bold Voices - August 2017 - Bundle Compliance Increases Survival, Reduces Delirium
Bold Voices - August 2017 - Members: Enhance Your Career With an AACN Scholarship
Bold Voices - August 2017 - Transitions
Bold Voices - August 2017 - President’s Note
Bold Voices - August 2017 - Cover3
Bold Voices - August 2017 - Cover4
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