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Why Gradual ABCDEF Bundle Implementation Often Results in a Failure to Launch

“Let’s introduce the bundle gradually. We don’t want to overwhelm anyone. Let’s see what the team is willing to do. We can start with awakening and breathing trials, then tackle the rest once we have those down.” This kind of conversation has echoed through medical organizations and clinical leadership teams for years. It’s a logical

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What Clinicians Need to Know About Awakening Trials

I have to admit, I wasn’t a fan of awakening trials at first. During my first two years in an Awake and Walking ICU, we rarely initiated sedation, so the need to turn it off wasn’t a struggle for us. When sedation was necessary, we simply turned it off when we deemed it unnecessary. It

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Reviving Core Nursing Values in Critical Care Through the ABCDEF Bundle

Critical care is an extraordinary and complex specialty that’s continually evolving, with a growing capacity to save and extend life in the face of the most extreme perils. Research, knowledge, and technological developments have transformed nursing skills and our ability to care for patients who are critically ill. Unfortunately, the nursing values and ethics, which

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How Failing to Practice the ABCDEF Bundle Creates Legal Liabilities in the ICU

As a nurse and a nurse advocate, I am passionate about protecting nurses and all ICU clinicians from falling victim to legal liabilities in the ICU. The alarming reality is that when hospitals fail to train and support their teams in keeping patients as awake and mobile as possible, everyone from hospital administrators to bedside

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Prehab vs. Rehab: Which Approach Should be Prioritized in the ICU?

For the past five years, I have been engrossed in exploring the history and current culture of the ICU, as they relate to the ABCDEF Bundle. As a result, I’ve been faced with having to compare my ingrained understanding of early mobility to the cultural “norms” I see at the bedside, as well as in

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Why ICU Culture Is a Barrier to Early Mobility

While it’s clear that the ABCDEF Bundle saves lives and helps to restore the quality of life for ICU survivors, many intensive care units continue to standardize deep sedation and immobility. But why is this? Why does one ICU use sedation on less than 20% of intubated patients, while another sedates 100% of these patients

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Sedation by Race: How Outdated ICU Practices Are Exacerbating Health Care Inequality for Hispanic Patients

Health care inequality in critical care medicine is multifactorial and negatively impacts patient outcomes [18]. During COVID-19, for instance, it was noted that Hispanic patients were more at risk of having severe COVID-19 infections, and despite their younger age, they had a higher mortality rate. Socioeconomic disparities, lack of access to health care, timing, and

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How the ABCDEF Bundle Can Mitigate RN Burnout

How the ABCDEF Bundle Can Help Mitigate RN Burnout

Nurses enter critical care medicine to alleviate human suffering, support patients in their most vulnerable moments, be patient advocates, do no harm, and save lives. But being a critical care nurse is physically, emotionally, and mentally challenging. Many factors have resulted in the loss of thousands of expert nurses, creating the staffing crisis we’re currently

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How ICU Staffing Ratios Relate to the Awake and Walking ICU Approach

The Awake and Walking ICU approach is deeply rooted in science, pathophysiology, and logic. Yet some of the best fruits of this method are humanity, compassion, dignity, and love. We use this approach to humanize the ICU, and I believe that is a desire of most ICU clinicians. But the reality is, no matter how

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The Financial Benefits of the ABCDEF Bundle

The ABCDEF Bundle is easily the best tool we have to improve patient care and outcomes in the ICU. If you know anything about these evidence-based practices, you’re probably well aware that they can decrease length of stay and readmissions, and reduce patients’ chances of dying, while making it more likely that they’ll return to

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