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Perceptions of Workload Burden and Adherence to ABCDE Bundle Among Intensive Care Providers

Background Use of the interprofessional Awakening and Breathing Coordination, Delirium Monitoring and Management, and Early Mobility (ABCDE) bundle is recommended practice in intensive care, but its adoption remains limited. Objective To examine the relationship between intensive care unit provider attitudes regarding the ABCDE bundle and ABCDE bundle adherence. Methods A 1‐time survey of 268 care providers in 10 intensive care units across the country who had worked at least 4 shifts per month to examine their attitudes toward workload burden, difficulty carrying out the bundle, perceived safety, confidence, and perceived strength of evidence. Logistic regression models were used to examine the relationship of unit‐level provider attitudes with ABCDE bundle adherence in 101 patients, adjusted for patients’ age, severity of illness, and comorbidity. Results For every unit increase in workload burden, adherence to the ABCDE bundle decreased 53% (odds ratio [OR], 0.47; 95% CI, 0.28–0.79; P = .004). Bundle difficulty (OR, 0.29; 95% CI, 0.08–1.07), perceived safety (OR, 0.51; 95% CI, 0.10–2.65), confidence (OR, 0.37, 95% CI, 0.10–1.35), and perceived strength of evidence (OR, 0.69; 95% CI, 0.14–3.35) were not associated with ABCDE bundle adherence. For every unit increase in perceived difficulty carrying out the bundle, adherence with early mobility was reduced 59% (OR, 0.41; 95% CI, 0.19–0.90; P = .03). In addition, ABCDE bundle adherence (ie, ventilator bundle) was less than DE bundle adherence (ie, ventilator‐free bundle) (97% vs 72%, z = 5.47; P < .001). Conclusions Focusing interventions on workload burden and factors influencing bundle difficulty may facilitate ABCDE bundle adherence.