Awakening-Breathing Coordination, Delirium Monitoring/Management & Early Mobility (ABCDE) Protocol

We face a profound and emerging public health problem in the form of acute and chronic brain
dysfunction among young and elderly intensive care unit (ICU) survivors that is altering the
landscape of society. Fully two-thirds of ICU patients develop delirium, which is associated
with longer stays, billions of dollars in costs globally, and 3-fold excess mortality at 6
months. Over one-half of ICU survivors suffer a functionally debilitating dementia-like
illness, which appears related to delirium duration. The impact on a person's life is often
devastating. The main goal of the proposed INQRI project is to implement, analyze, and
disseminate an evidence-based, nurse-led, inter-professional, multi-component program focused
on improving the care and outcomes of critically ill adults. The study will focus on applying
Awakening-Breathing Coordination, Delirium Monitoring/Management & Early Mobility (ABCDE), a
program of delirium screening, prevention, and treatment developed at Vanderbilt University.
The ABCDE approach analyzes and merges the best available evidence related to delirium,
analgesia, and sedation (DAS) management in the ICU and tailors the pharmacologic and
nonpharmacologic interventions used in prior DAS clinical trials into a program that can be
adopted into practice in less "research focused" ICUs. Specifically, the study aims are to
(1) implement the ABCDE program in a medical center that does not currently perform routine
ICU delirium screenings and identify facilitators and barriers to program adoption; (2) test
the impact of the ABCDE program on patient outcomes, nursing quality outcomes, and system
outcomes; and (3) assess the extent to which ABCDE implementation is effective, sustainable,
and conducive to dissemination into other settings.

Inclusion Criteria:

- Greater than or equal to 19 years of age

- Patients at the University of Nebraska Medical Center and the Nebraska Medical Center

- Admitted to either the academic medical or trauma critical care service

Exclusion Criteria:

- Legally authorized representative not available to provide consent to participate
within 48 hours of ICU admission