Date of Award


Document Type

Open Access Dissertation


College of Nursing


Nursing Practice

First Advisor

Beverly Baliko

Second Advisor

Joan M. Culley


Quality improvement projects contribute to the development of evidence-based management strategies for successful implementation of evidence-based practices in health care, thus reducing the risk of change implementation failure. This study assessed practice change implementation strategies for the awakening and breathing trial coordination, delirium assessment and management, early exercise and mobility (ABCDE) bundle. The ABCDE bundle is an evidence-based, interdisciplinary framework for managing pain, agitation, and delirium, reducing the duration of mechanical ventilation, and supporting early mobility in critically ill patients. The purpose of this study was to implement a nurse-driven initiative to design and put into place an evidence-based approach to prepare interdisciplinary team members in the medical-surgical intensive care unit (MSICU) at the Medical University of South Carolina for implementation of the ABCDE bundle. The study was guided by Raelin’s Model of Work-Based Learning (2008). A pre-intervention survey assessed (a) individual learning preferences, (b) bundle familiarity, (c) communication and collaboration, (d) current bundle practices, and (e) unit processes. The intervention phase consisted of unit-specific educational interventions based on pre-intervention survey results. A post-intervention survey assessed (a) bundle knowledge, (b) effectiveness of educational methods, (c) perceived barriers and facilitators, (d) suggestions for implementation, and (e) ongoing educational needs.

Overall results revealed specific educational needs of specialties within the MSICU interdisciplinary team and demonstrated the importance of understanding unitspecific needs on both the individual and collective levels. Results indicated the need for additional education and training regarding early exercise and progressive mobility; therefore, complete and successful educational preparation of the MSICU interdisciplinary team was not achieved. This quality improvement project was the first step in the ABCDE bundle implementation process for the MSICU. Upon project completion, MSICU leaders continued progressing towards full bundle implementation by creating the interdisciplinary ABCDE bundle committee within the established shared governance practice council. The committee will support interdisciplinary team buy-in and ensure the dissemination and evaluation of continued bundle education along with more in-depth education regarding early exercise and progressive mobility. Evidencebased management strategies utilized in this study may be applied to future implementation efforts and may enhance the sustainment of future practice changes.


© 2015, Jessica Murner Hamilton

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