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1262: ICU LIBERATION NURSE PRACTITIONER-LED IMPLEMENTATION OF THE ABCDEF BUNDLE IN A VA HOSPITAL

www.ccmjournal.org Critical Care Medicine • Volume 46 • Number 1 (Supplement) Learning Objectives: The ABCDEF Bundle (Assess, Manage and Treat Pain; Both Sedation Awakening and Spontaneous Breathing Trials; Choice of Sedation; Delirium Monitoring and Management; Early Mobility; Family Support) is a set of evidence-based guidelines that have been shown to improve outcomes in adult ICU patients. A team of Critical Care Nurse Practitioners oversaw implementation of the ABCDEF Bundle in the Medical-Surgical ICU at the Palo Alto Veteran’s Affairs Hospital over a three-year period commencing in 2014. Methods: Our ICU was selected to participate in the ABCDEF Bundle Collaborative facilitated by the Society of Critical Care Medicine in 2015–2017. The subprojects that we implemented in our ICU included introduction of a targeted sedation strategy protocol, addition of a Sedation Awakening Trial (SAT) to our existing Spontaneous Breathing Trial (SBT) protocol, a delirium order set, an early mobility program, and restructuring multidisciplinary rounds to allow for formal presentations by the bedside nurse. Both retrospective (pre-bundle implementation) and prospective patient data was collected as part of our participation in the ABCDEF Bundle Collaborative. Over a two-year period we tracked delirium, sedation levels, and ABCDEF bundle compliance in 270 patients for a total of 1136 patient days of care. Additionally, ICU length of stay was tracked for all patients requiring ICU admission in an existing VA database. Results: The number of patients experiencing deep sedation (RASS -4 or -5) decreased from 47% to 29%, a 38% reduction. Of the patients in deep sedation, the duration of deep sedation decreased from 2.2 days to 1.8 days, a 15% reduction. The rate of patients that screened positive for delirium decreased from 23% to 18%, a 22% reduction. The duration of delirium among those delirious decreased from 3.14 days to 2.24 days, a 28% reduction. Average ICU length of stay decreased from 4.93 days in 2013 to 4.24 days in 2016, a 14% reduction. Conclusions: Critical Care Nurse Practitioners are ideally positioned to lead complex quality improvement projects in the ICU. The improved patient outcomes we observed in our ICU translated to a 14% decrease in ICU length of stay.