(精选)【体外膜肺ECMO精品课件】 Applying the “ABCDE” Bundle into Clinical Practice教学课件.pptVIP

Applying the “ABCDE” Bundle into Clinical Practice;Epidemiology ICU-Acquired Delirium Weakness;OUTCOMES ASSOCIATED WITH DELIRUM;OUTCOMES ASSOCIATED WITH DELIRIUM;OUTCOMES ASSOCIATED WITH ICU-AW;ICU OUTCOMES;WHO IS RESPONSIBLE FOR IMPROVING OUTCOMES?;Study Aims Implement the ABCDE bundle in a medical center that does not currently perform routine ICU delirium screenings identify facilitators barriers to program adoption Test the impact of the ABCDE program on patient, nursing quality, system outcomes Assess the extent to which ABCDE implementation is effective, sustainable, conducive to dissemination into other settings;THE STORYWHAT WE DID;THE STORYTHIS IS WHAT “WE” DEVELOPED;ABC “STEPS”;University of Nebraska Medical Center;Step 1 –SAT Safety Screen-RN Driven;SAT Failure Questions RASS score 2 for 5 minutes Sa02 88 % for 5 minutes Respirations 35 BPM for 5 minutes New Acute Cardiac Arrhythmia ICP 20 2 or more of the following symptoms of respiratory distress: HR increase 20 or more BPM, HR 55 BPM, Use of accessory muscles, Abdominal paradox, Diaphoresis, Dyspnea;SBT Safety Screen Questions Is patient a chronic/ventilator dependent patient? Is patient SpO2 88%? Is patient’s FiO2 50%? Is patient’s set PEEP 7? Is there documentation of myocardial ischemia in the past 24 hours? Is the patient currently on vasopressor medications? Is patient’s intracranial Pressures 20? Is patient receiving mechanical ventilation in an attempt to control ICP? Does the patient lack inspiratory effort? ;Step 4-Perform SBT-RT Driven;WHY IS DELIRIUM SO CONFUSING?;Delirium Monitoring Management;What is the CAM-ICU? ;Delirium Monitoring Management;NONPHARMACOLOGIC APPROACHES TO PREVENTING TREATING DELIRIUM;Early Mobility-Safety Screen-RN Driven;Early Mobility Progression;ABCDE SUMMARY POINTS;ABCDE SUMMARY POINTS;OUR GOAL!;University of Nebraska Medical Center