Bundle of Care

Isabella Tate
OCCT 520: Neurological Sensorimotor Functions II
Dr. Elizabeth DeIullis, OTD, MOT, OTR/L
February 6, 2023
 i s i t ?
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A guide for clinicians to use when determining the needs of ICU
patients

This is flexible to implement

Guides well-rounded patient care and optimize resources

Components

Assess, Both Choice of Delirium: Early Family

Prevent, Spontaneous analgesia assess, mobility engagement and
and Awakening and prevent, and empowerment
Manage Trials (SAT) sedation and exercise
Pain & manage
Spontaneous
Breathing
Trials (SBT)
 ● First step before pain relief is administered
● Patient self-report of pain is the goal standard
○ In the absence of patient self-report, behavioral and
physiological indicators become the most important
 Behavioral Pain
Scale (BPS) and
Critical-Care Pain
Assess, Observation Tool
(CPOT) are the most
Prevent, valid and reliable
and behavioral pain
scales for ICU
Manage patients
Pain o Once pain is identified,
then management

(Marra et al., 2017)

 ● Spontaneous Awakening Trials (SAT)
○ A period of time when sedation medicine is stopped to
determine whether a patient requires sedation or can be
managed without sedatives
○ Daily interruption of sedation shortens the duration of
ventilation and ICU stay
Both Spontaneous ● Spontaneous Breathing Trials (SBT)
Awakening Trials ○ A period of time when ventilation is stopped to determine
(SAT) & whether a patient requires ventilation or can breathe
Spontaneous successfully on their own
Breathing Trials ● Coordination of these two techniques includes
(SBT)
weaning off narcotics/sedation resulting in
decreased ventilation requirements
(Marra et al., 2017)
(Garrad et al., 2020)
 ● Goal-directed delivery of psychoactive medications to
avoid over-sedation, promote earlier removal of tubes,
and help interdisciplinaries agree on a sedation level
○ Scales such as the Richmond Agitation-Sedation Scale (RASS) or
the Riker Sedation-Agitation Scale (SAS) determines need
Choice of ● Analgesia: the inability to feel pain
analgesia ● Maximizing patient outcomes is driven by choose
and sedatives and analgesic medications
sedation ○ Factors in doses and discontinuation

(Marra et al., 2017)

Choice of
analgesia
and
sedation

(Marra et al., 2017)

 ● Over 80% of patients develop delirium during their
hospital stay, majority of them in the ICU
● Can lead to increased ventilation, longer ICU stay,
increased cost, long-term cognitive impairment, and
mortality
Delirium: ● Several methods have been designed to diagnose
assess, delirium
prevent, and ○ Confusion Assessment Method for the Intensive Care Unit
manage (CAM-ICU) & Intensive Care Delirium Screening Checklist
(ICDSC) are most frequently used
● Management: medications

(Marra et al., 2017)

 Delirium:
assess,
prevent, and
manage

(Marra et al., 2017)

Delirium Protocol

(Marra et al., 2017)

 ● Huge part of the bundle and the only
intervention resulting in decreased delirium
○ During ICU stays, patients can lose up to 25%
peripheral muscle within 4 days of ventilation and 18%
Early body weight by the time of discharge

mobility ● This should begin in the ICU and continue all

and the way to recovery @ home
● Collaboration with medicine, nursing, and PT is
exercise
necessary

(Marra et al., 2017)

 ● No ICU treatment plan is complete without
incorporation of the family’s wishes, concerns,
questions, and participation
Family ● Here is where patient preferences can be identified,
engagement and anxiety of families can be lessened, and physicians
empowerment can give input for decisions
● Not only recognizing the needs of the patient but the
needs of the family as well

(Marra et al., 2017)

 rn ?
w e lea
h a t ca n
W How to aid patients in early ICU treatment

Pain management interventions other than medications

Early mobility and ADL training can be impactful in recovery

References
Girard, T. D., Gargett, K. D., & Singh, J. S. (2020). Chapter 3: Spontaneous awakening

and breathing trials. In Posa, P., Singh, J. S., & Stollings, J. L. (Eds). ICU

liberation. (2nd ed., pp. 19-30) Society of Critical Care Medicine.

Marra, A., Ely, E. W., Pandharipande, P. P., & Patel, M. B. (2017). The ABCDEF Bundle

in critical care. Critical Care Clinics, 33(2), 225–243.

https://doi.org/10.1016/j.ccc.2016.12.005