Practical Advice for Implementing the ABCDEF Bundle

Feb 04, 2019

Added to Collection

Articles in Critical Care Nurse share strategies from the ICU Liberation ABCDEF Bundle Improvement Collaborative for overcoming barriers to integrating the bundle into clinical practice

ALISO VIEJO, Calif. – Feb. 4, 2019 – Although growing evidence supports the safety and effectiveness of an assortment of clinical interventions for critically ill patients known as the ABCDEF bundle, critical care providers often struggle with how to incorporate the various elements into clinical practice.

The bundle integrates pain, sedation and delirium management with ventilator weaning, early mobility efforts and family engagement into a single collection of evidence-based best practices.

According to the Society of Critical Care Medicine (SCCM), components of the ABCDEF bundle individually and collectively can help reduce delirium, improve pain management and reduce long-term consequences for adult intensive care unit (ICU) patients.

SCCM received a grant from the Gordon and Betty More Foundation to support the ICU Liberation ABCDEF Bundle Improvement Collaborative, a 20-month, nationwide quality  improvement initiative designed to promote widespread dissemination and implementation of the bundle.

From 2015 to 2016, 68 adult and nine pediatric hospitals from 29 states and Puerto Rico participated in the Collaborative, representing academic, community and federal hospitals from both rural and urban areas.

An interprofessional team with expertise in ABCDEF bundle implementation and quality improvement served as faculty for the Collaborative, helping critical care providers at individual sites through the adoption of the bundle in their ICUs.

Through in-person meetings and email discussions, the Collaborative identified the most common and challenging barriers to bundle implementation experienced by participating sites.

Two articles in the February issue of Critical Care Nurse (CCN) provide practical advice from these leading experts on effective strategies for overcoming the barriers.

In “Implementing the ABCDEF Bundle: Top 8 Questions Asked During the ICU Liberation ABCDEF Bundle Improvement Collaborative,” the team describes the most frequently asked questions and provides practical advice for other institutions implementing the bundle. The questions cover each element of the ABCDEF bundle, as well as teamwork and process improvement.

A second article, “Common Challenges to Effective ABCDEF Bundle Implementation: The ICU Liberation Campaign Experience,” discusses some of the most challenging implementation issues that Collaborative teams experienced and recommends specific strategies to overcome the barriers.

“Each member of the ICU team, including patients and their families, offers unique contributions that are essential to implementing the ABCDEF bundle and delivering patient-centered care in the ICU,” said Joanna Stollings, PharmD, a Collaborative faculty member and co-author of the articles. She is a clinical pharmacist in the department of pharmaceutical services, Vanderbilt University Medical Center (VUMC), Nashville, Tennessee. “Critical care staff can use the strategies provided by the Collaborative to facilitate their efforts to adopt the bundle.”

SCCM offers an online resource library as part of its ICU Liberation initiative to encourage widespread use of the ABCDEF bundle. Additional clinical resources related to the ABCDEF bundle are available from the American Association of Critical-Care Nurses (AACN), which publishes CCN.

Clinicians should also refer to the recently published 2018 SCCM Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU (PADIS), as they boost ABCDEF bundle implementation efforts. As part of its AACN Critical Care Webinar Series, AACN hosts a webinar Feb. 14 to present the PADIS guidelines’ recommendations on the management of patients with pain, agitation and delirium, and the impact on clinical practice. Brenda Pun, DNP, RN, an advanced practice nurse at VUMC and one of the Collaborative’s faculty members, will lead the webinar.

As AACN’s bimonthly clinical practice journal for high-acuity and critical care nurses, CCN is a trusted source of information related to the bedside care of critically and acutely ill patients.

Access the article abstract and full-text PDF by visiting the CCN website at

About Critical Care Nurse: Critical Care Nurse (CCN), a bimonthly clinical practice journal published by the American Association of Critical-Care Nurses, provides current, relevant and useful information about the bedside care of critically and acutely ill patients. The award-winning journal also offers columns on traditional and emerging issues across the spectrum of critical care, keeping critical care nurses informed on topics that affect their practice in high-acuity, progressive and critical care settings. CCN enjoys a circulation of more than 120,000 and can be accessed at

About the American Association of Critical-Care Nurses:Founded in 1969 with 400 members, the American Association of Critical-Care Nurses (AACN) is now the world’s largest specialty nursing organization. In 2019, AACN celebrates 50 years of acute and critical care nursing excellence, serving more than 120,000 members and over 200 chapters in the United States. The organization remains committed to its vision of creating a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. During its 50th anniversary year, AACN continues to salute and celebrate all that nurses have accomplished over the last half century, while honoring their past, present and future impact on the evolution of high-acuity and critical care nursing.

American Association of Critical-Care Nurses, 101 Columbia, Aliso Viejo, CA 92656-4109; 949-362-2000;;;