Research On The Cognition Of ICU Medical Staff And The Practice In ICU For ABCDEF Bundle Strategy

Objective:To describe the cognition level of the center ICU medical staff and the practice status of the center ICU on ABCDEF bundle strategy in the 3A Grade Hospitals of Sichuan provinceand to identify the influencing factors.Methods:On the basis of literature review and expert consultation,ICU ABCDEF bundle strategy cognition,practice status and influencing factors questionnaires were designed.An cross-sectional survey was conducted among 43 central ICU and its medical workers who met the inclusion and exclusion criteria.SPSS21.0 statistical software was used for statistical processing of the data.Descriptive statistics,univariate analysis,t-test,multiple linear regression analysis and other statistical methods were used.Results:A total of 40 central ICU and their 469 medical workers' questionnaires were obtained.Of which,433 medical workers' questionnaires were valid.1.Thescoreof knowledge was 10.50±4.62(the total score was 21).The three lowestelements were element A(30.6%),element B(47.7%)and element C(38.5%).2.The score of attitude was 35.55±3.76(the total score was 50).The three lowest score items were the human resource burden(1.96±0.89),difficulty(2.15±0.87)and adverse events(2.17±0.85).3.The results of single factor analysis showed that the knowledge score was related to age,ICUworkyears,post,education background,professional title,employment form,whether ICU specialist nurse and training(P<0.01);the attitude score was related to age,position,professionaltitle and training(P<0.01 or P<0.05).Multiple regression analysis show post,education background and training were the main influence factors of knowledge,post and training were the main influence factors of attitude.4.Practice status:(1)Only 2.5%of ICUs "always" performed multidisciplinary ward rounds on a daily basis.(2)Among patients on both invasive and noninvasive mechanical ventilation,the pain assessment tool with the highest percentage of "always" use was CPOT,and the highest percentage of'never" use was BPS.(3)While 80.0%of ICUs were "always"and "often" implementing SAT and SBT daily,only 10.0%were "always"implementing a standardized process,(4)RASS,Ramsay and SAS were"always" used in 52.5%,22.5%and 10.0%of the ICUsrespectively.The"always" and "often" selected analgesics and sedatives mainly focus on sufentanil,propofol,midazolam and dexmedetomidine.(5)"Always"CAM-ICU and ICDSC assessments were used in 35.0%and 12.5%of ICUs,respectively.Dexmedetomidine is a major treatment for delirium in the ICU.Non-drug measures for delirium control were "always" and "often" used in ICU?85.0%,except for early activity.(6)Both "always" and "often" assessed the patient's mobility during daily rounds in 82.5%of ICUs,and 42.5%of ICUs never had a respiratory therapist involved in the patient's early activity.(7)Only 12.5%of ICUs that "always" implemented family appointment visits,and 55.0%never allowed family members to participate in staff rounds,Only 7.5%of the ICUs that "always" let family members engaged in the early activities,and no hospital kept an ICU log all the time.5.The main implementation influencing factors:(1)in the aspect of patients and families was "hemodynamic instability"(67.0%);(2)in the aspect of medical personnel was "lack of knowledge of the strategy"(64.2%);(3)intheaspectofthe strategy itself was "the potential burden of human"(88.2%);(4)in the aspect of ICU environment was "lack of communication and cooperation among multidisciplinary teams"(50.8%).6.The medical staff think the biggest obstacle affecting the bundle strategyimplementation was:insufficient human resources(36.0%),lack of knowledge and no systematic training(32.6%).Conclusion:1.The evidence-based knowledge related to the ABCDEF bundle strategy is not well grasped by ICU medical staff,post,education background and training were the main influence factors;they agree with the strategy,but still worry aboutits potential human resource burden,difficulty and adverse events,post and training were the main influence factors.2.The establishment status of multidisciplinary team in ICU is less optimistic.There is a general shortage of other professional medical personnelother than doctors and nurses in the ICU.The overall practice status of multidisciplinary team communication and cooperation is not optimistic and needs to be further improved.3.The overall practice status of each element in the ABCDEF bundle strategy in ICU is uneven,and the implementation is not ideal in the use of various assessment tools,standard procedures for SAT and SBT implementation,multidisciplinary participation in the implementation of early activities,family participation and empowerment.4.The main factors influencing the implementation of ICU ABCDEF bundle strategy:(1)in the aspect of patients and families was patients' hemodynamic instability.(2)in the aspect of clinical medical personnel was lack of knowledge of the strategy.(3)in the aspect of strategy itself was the potential burden of human.(4)intheaspectofICU environment was lack of communication and cooperation among multidisciplinary teams.5.The medical staff think the biggest implementationobstacle was shortage of human resources,lack of knowledge and systematic training.