Pls fill in table ( must interpret p-value in tables , table is attached with articles

Pls fill in table ( must interpret p-value in tables , table is attached with articles
Literature Evaluation Table – DPI Intervention Learner Name: Instructions: Use this table to evaluate and record the literature gathered for your DPI Project. Refer to the assignment instructions for guidance on completing the various sections. Empirical research articles must be published within 5 years of your anticipated graduation date. Add or delete rows as needed. PICOT-D Question: In adult patients in a high observation unit in a long-term acute care hospital in Virginia, will the translation of Hsieh et al. research implementing the ABCDEF bundle, compared to current practice reduce length of stay over an eight-week period? Table 1: Primary Quantitative Research – Intervention (5 Articles) complete table with listed articles APA Reference (Include the GCU permalink or working link used to access the article.) Research Questions/ Hypothesis, and Purpose/Aim of Study Type of Primary Research Design Research Methodology Setting/Sample (Type, country, number of participants in study) Methods (instruments used; state if instruments can be used in the DPI project) How was the data collected? Interpretation of Data (State p-value: acceptable range is p= 0.000 – p= 0. 05 ) Outcomes/Key Findings (Succinctly states all study results applicable to the DPI Project.) Limitations of Study and Biases Recommendations for Future Research Explanation of How the Article Supports Your Proposed Intervention Hsieh, S. J., Otusanya, O., Gershengorn, H. B., Hope, A. A., Dayton, C., Levi, D., Garcia, M., Prince, D., Mills, M., Fein, D., Colman, S., & Gong, M. N. (2019). Staged implementation of awakening and breathing, coordination, delirium monitoring and management, and early mobilization bundle improves patient outcomes and reduces hospital costs. Critical Care Medicine, 47(7), 885–893. https://doi-org.lopes.idm.oclc.org/10.1097/CCM.0000000000003765 https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=cmedm&AN=30985390&site=eds-live&scope=site&custid=s8333196&groupid=main&profile=eds1 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6579661/ The research question aimed at measuring the impact of staged implementation of complete versus virtual ABCDE bundle on mechanical ventilation (MV) duration, intensive care unit (ICU) and hospital length of stay(LOS), and cost Prospective cohort study The study included two medical ICUs within Montefiore Healthcare Center (Bronx, New York). The study also included 1855 mechanically ventilated patients admitted to ICUs between July 2011 – July 2014. After early coordination (EC) was implemented (period 2), 65% of patients stood, 54% walked at least once during their ICU stay, and ICU-acquired pressure ulcers and physical restraint use decreased (period 1 vs 2: 39% vs 23% of patients; 30% vs 26% patient days, respectively; p < 0.001 for both). After adjustment for patient-level covariates, implementation of the full (B-AD-EC) versus partial (B-AD) bundle was associated with reduced mechanical ventilation duration (–22.3%; 95% CI, –22.5% to –22.0%; p < 0.001), ICU length of p<0.05 Early mobilization and coordination (EC) portrayed improvement of patients in ICU by 30% Implementation of full (B-AD-EC) vs (B-AD) resulted to a decrease in MV duration. Implementation of ABCDE bundle reduced total ICU and hospital cost by 24.2% and 30.2% respectively. The study experienced the challenge of unmeasured changes which could have affected the results The study also was conducted in a single medical center hence limiting generalizability. The study also may have experienced cross-contamination of practices between two ICUs The study was unable to compare costs between two seasonal periods due to cost-to-charge ratios changes hence study used smaller cohort for cost analyses. The study did not collect all the data in the partial bundle ICU for comparison There is need for physicians to acquire training on implementing ABCDE bundle to improve patient’s conditions on ICU and reduce length of hospital stay. There is need for teamwork between physicians in ICU to enhance patient’s health and medication adherence. There is need for improvement of working conditions in health facilities to safeguard patient’s health. This article accessed the impact of implementing complete versus virtual ABCDE bundle on mechanical ventilation (MV) duration, intensive care Unit (ICU)and hospital length of stay (LOS), and cost. However, the article has also determined that early mobilization and structured condition of ABCDE bundle results to a spontaneous awakening, breathing, and delirium management leading to reduced mechanical duration (MV), length of hospital stay and the cost. Schallom, M., Tymkew, H., Vyers, K., Prentice, D., Sona, C., Norris, T., & Arroyo, C. (2020). Implementation of an interdisciplinary AACN early mobility protocol. Critical Care Nurse, 40(4), e7–e17. https://doi-org.lopes.idm.oclc.org/10.4037/ccn2020632 https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=146029040&site=eds-live&scope=site&custid=s8333196&groupid=main&profile=eds1 To examine the impact of an interdisciplinary mobility protocol in 7 specialty intensive care units that previously implemented other bundle components. quality improvement project using the American Association of Critical-Care Nurses mobility protocol The project was conducted at a 1200-bed, university affiliated level I trauma medical center in the Midwest with 132 ICU beds at project initiation. QI preintervention-postintervention design was used The American Association of Critical-Care Nurses (AACN) early progressive mobility protocol was used, The Richmond Agitation-Sedation Scale (RASS) The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) was also used. All data were downloaded from REDCap into IBM SPSS Statistics, version 22 using descriptive statistics Level of significance for pre-implementation post implementation differences was set at a = 0.05. (p <0.05) In phase 1, the mean (SD) mobility level increased in all intensive care units, from 1.45 (1.03) before to 1.64 (1.03) after implementation (P < .001). Mean (SD) ICU Mobility Scale scores increased on initial evaluation from 4.4 (2.8) to 5.0 (2.8) (P = .01) and at intensive care unit discharge from 6.4 (2.5) to 6.8 (2.3) (P = .04). Complications occurred in 0.2% of patients mobilized. In phase 2, 84% of patients had out-of-bed activity after implementation. The time to achieve mobility levels 2 to 4 decreased (P = .05). Intensive care unit length of stay decreased significantly in both phases. QI initiatives using retrospective reviews of medical records The data we extracted from the EMR were dependent on documentation quality. Another limitation is fidelity to the intervention implementation. Implementing the ABCDEF bundle can produce significant impact on pt outcomes. Implementing the E and produce greater results This study adds great significance to my DPI project as it clearly identifies implementation of the ABCDEF bundle can reduce length of stay in the ICU setting. Fill in table Frade-Mera, M. J., Arias-Rivera, S., Zaragoza-García, I., Martí, J. D., Gallart, E., San José-Arribas, A., Velasco-Sanz, T. R., Blazquez-Martínez, E., & Raurell-Torredà, M. (2022). The impact of ABCDE bundle implementation on patient outcomes: A nationwide cohort study. Nursing in Critical Care. https://doi-org.lopes.idm.oclc.org/10.1111/nicc.12740 https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=cmedm&AN=34994034&site=eds-live&scope=site&custid=s8333196&groupid=main&profile=eds1 * Collinsworth, A. W., Brown, R., Cole, L., Jungeblut, C., Kouznetsova, M., Qiu, T., Richter, K. M., Smith, S., & Masica, A. L. (2021). Implementation and routinization of the ABCDE bundle: A mixed methods evaluation. dimensions of critical care nursing : DCCN, 40(6), 333–344. https://doi-org.lopes.idm.oclc.org/10.1097/DCC.0000000000000495 https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=cmedm&AN=34606224&site=eds-live&scope=site&custid=s8333196&groupid=main&profile=eds1 The study determines how to facilitate ABCDE bundle adoption by analyzing different implementation strategies on bundle adherence rates. The study also aims at assessing clinician’s perception of the bundle and the implementation effort. Mixed method eval The study examined effect of 2 bundle implementation on 8 patient adults in ICU. Electronic Health Record(EHR) modification was used as the primary strategy while enhanced strategy uses HER plus additional bundle training 84 nurses, therapists and physicians participated in the survey. Effect of Basic vs Enhanced Intervention on Bundle Adherence ICU LOS 0.02 (0.01-0.02) <.0001a (p <0.05 The response from the participants show that bundle use resulted in best care and patient outcomes. After bundle implementation process, ICUs in both interventions showed improvement in bundle adherence ICUs in the basic intervention outperformed others after initiating own implementation strategies. Data collection was time consuming The study acquired data through HER hence limited to evaluating some elements such as pain and sedation Physicians response on bundle perception may be biased. There is need for adequate training for physicians on how best to implement ABCDE bundle to improve care for patients Promote teamwork to enhance coordination between healthcare professionals for easier implementation of ABCDE bundle. The article highlights the effects of applying ABCDE bundle in healthcare for the patients in ICU It scores the fact that proper implementation of ABCDE bundles results to improvement in nursing care and patient outcomes. Pun, B. T., Balas, M. C., Barnes-Daly, M. A., Thompson, J. L., Aldrich, J. M., Barr, J., Byrum, D., Carson, S. S., Devlin, J. W., Engel, H. J., Esbrook, C. L., Hargett, K. D., Harmon, L., Hielsberg, C., Jackson, J. C., Kelly, T. L., Kumar, V., Millner, L., Morse, A., … Ely, E. W. (2019). Caring for critically ill patients with the ABCDEF bundle: Results of the ICU liberation collaborative in Over 15,000 adults. Critical Care Medicine, 47(1), 3–14. https://doi-org.lopes.idm.oclc.org/10.1097/CCM.0000000000003482 https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=cmedm&AN=30339549&site=eds-live&scope=site&custid=s8333196&groupid=main&profile=eds1https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6298815 The study aim at evaluating the relationship between ABCDEF bundle performance and patient-centered outcomes in critical care. Prospective cohort study from national quality improvement collaborative The research collected a 20-month period data on 68 academics, community, and federal ICUs The study also included 15226 patient adults and at least one ICU every day. There was a consistent dose-response relationship between higher proportional bundle performance and improvements in each of the above-mentioned clinical outcomes (all p < 0.002). Significant pain was more frequently reported as bundle performance proportionally increased (p = 0.0001). p < 0.002 Complete ABCDE bundle performance demonstrated a reduction in mortality rate within 7 days, mechanical ventilation, delirium and physical restraint use. Patients also demonstrated an increased dose response relationship between higher proportion bundle performance. Frequent pain was reported with increased bundle performance.  The study did not use a randomized study design, nor did it have access to concurrent control. ICU liberation collaborative included numerous ICU types as part of a larger effort to understand the impact of the ABCDE bundle on various types of critically ill patients while understanding the implementation strategies unique to each setting. The patient-level outcomes are not wholly independent of one another and are assessed within a short time frame during which patients did not experience those outcomes.   The ICU liberation collaborative study lacked sufficient funds to support data accuracy auditing. Cohort analysis is from patient data collected within a larger QI project that collected a minimum and de-identified dataset, limiting the study’s ability to answer some questions. Physicians ought to familiarize with ABCDE bundle performance to enhance patients’ dose adherence to the critically ill adults in ICU. Physicians need to collaborate with other professionals in health sector and attend to ICU cases with open minded ready to learn from others. The article analyzes measures to take in caring for the critically ill patients in ICU with ABCDEF bundle with reference to the results of the ICU liberation collaborative of over 15000 adults. The article however outlined the relationship between ABCDEF bundle performance and patient centered outcomes in critical care. Therefore, it is clear that ABCDEF bundle performance portray significant clinical improvements in patient survival, mechanical ventilation use, coma and delirium, restraint free care, ICU re-admissions and post ICU discharge disposition. Table 2: Additional Primary and Secondary Quantitative Research (10 Articles) complete table with listed articles APA Reference (Include the GCU permalink or working link used to access the article.) Research Questions/ Hypothesis, and Purpose/Aim of Study Type of Primary or Secondary Research Design Research Methodology Setting/Sample (Type, country, number of participants in study) Methods (instruments used; state if instruments can be used in the DPI project) How was the data collected? Interpretation of Data (State p-value: acceptable range is p= 0.000 – p= 0.05) Outcomes/Key Findings (Succinctly states all study results applicable to the DPI Project.) Limitations of Study and Biases Recommendations for Future Research Explanation of How the Article Supports Your Proposed DPI Project Barnes-Daly, M. A., Phillips, G., & Ely, E. W. (2017). Improving hospital survival and reducing brain dysfunction at seven California community hospitals: Implementing PAD guidelines via the ABCDEF bundle in 6,064 patients. Critical Care Medicine, 45(2), 171–178. https://doi-org.lopes.idm.oclc.org/10.1097/CCM.0000000000002149 https://ubccriticalcaremedicine.ca/academic/jc_article/Improving%20Hospital%20Survival%20and%20Reducing%20Brain%20Dysfunction%20(Jan-19-17).pdf The research question was tailored on tracking compliance by an interprofessional team with the (ABCDEF) bundle in enforcing the Agitation, Pain, and Delirium procedures. The aim was to examine the connection between ABCDEF bundle compliance and consequences, including clinic survival and delirium-free and coma-free days in community infirmaries A prospective cohort quality improvement initiative involving ICU patients. 1. Random selection of 1 patient from the daily census at each hospital 2. Study included patients who were 66 years or older with a diagnosis of AMI. Exclusion criteria included age <66 years, primary diagnosis of a noncardiac etiology (e.g., sepsis), and a transfer from another acute care hospital. Data collection Data on patient characteristics, processes of care, and outcomes were collected during the baseline period (January 1, 2008, to July 31, 2009) and during the follow-up period (August 1, 2009, to September 30, 2011) for a total of 2 years of data. For every 10% increase in total bundle compliance, patients had a 7% higher odds of hospital survival (odds ratio, 1.07; 95% CI, 1.04–1.11; p < 0.001). Likewise, for every 10% increase in partial bundle compliance, patients had a 15% higher hospital survival (odds ratio, 1.15; 95% CI, 1.09–1.22; p < 0.001). These results were even more striking (12% and 23% higher odds of survival per 10% increase in bundle compliance, respectively, p < 0.001) in a sensitivity analysis removing ICU patients identified as receiving palliative care. Patients experienced more days alive and free of delirium and coma with both total bundle compliance (incident rate ratio, 1.02; 95% CI, 1.01–1.04; p = 0.004) and partial bundle compliance (incident rate ratio, 1.15; 95% CI, 1.09–1.22; p < 0.001). P < 0.05  The mortality rate for patients with sepsis was decreased by 42 percent (from 20.7 percent to 12.1 percent) in the 23 months after implementation of the ABCDEF bundle, compared with the 21 months before the institution of the bundle. Mortality rates for patients with pneumonia were also lower after bundle implementation (35.4 percent before the intervention vs. 28 percent afterward) The number of days’ patients spent in the intensive care unit within 30 days after arriving at the hospital was reduced by an average of 1.7 days for patients who had sepsis, and by an average of 1.5 days for those with pneumonia The number of brain dysfunction events (such as coma, seizures, and infection) within 30 days after an ICU admission dropped by 36 percent improving Hospital Survival and Reducing Brain Dysfunction at Seven California Community Hospitals: Implementing PAD Guidelines Via the ABCDEF Bundle in 6,064 Patients. First, this QI project lacked the strict protocols found in randomized, controlled trials. The design and sample size benefits of the investigation did not trump other statistical concerns. - Physicians need further education on guidelines and protocols, as well as how to collaborate with other physicians and experts. - Physical environment needs to be improved along with an organized system for transferring patients. - Physicians should be more open to changing their thought process. - Better communication between nurse and physician needs to be encouraged, as well as between physicians and experts such as cardiologists. The article describes the implementation of acute care for older adults’ guidelines at seven California community hospitals and has been used to determine whether a regional quality improvement initiative is associated with improved hospital survival, functional status, and intensive care unit (ICU) length of stay after acute myocardial infarction (AMI). The article also determined whether a regional quality improvement initiative is associated with improved hospital survival, functional status, and ICU length of stay after AMI. Balas, M. C., Tan, A., Pun, B. T., Ely, E. W., Carson, S. S., Mion, L., Barnes-Daly, M. A., & Vasilevskis, E. E. (2022) Effects of a national quality improvement collaborative on ABCDEF bundle implementation. American Journal of Critical Care, 31(1), 54–64. https://doi-org.lopes.idm.oclc.org/10.4037/ajcc2022768 https://aacnjournals.org/ajcconline/article-abstract/31/1/54/31644/Effects-of-a-National-Quality-Improvement?redirectedFrom=fulltext What are the effect of quality improvement collaborative participation on ABCDEF bundle performance? This study examined the NQIC's impact on the implementation of the six components of the ABCDEF Bundle in four types of hospitals: The authors hypothesized that with an increase in safety culture, there would be an increased implementation of the ABCDEF Bundle. The purpose of this study was to determine whether the ABCDEF Bundle could be implemented in a variety of hospitals across the United States with a focus on safety culture. Quasi-experimental design This study used a non-experimental design to determine the impact of the ABCDEF Bundle on safety culture, defined as the degree to which a system is characterized by attention to safety in tasks, relationships, and attitudes. The study included 114 acute care hospitals that were participating in the NQIC. In the ARISE and ProCESS trials, ABCDEF Bundle reduced ICU mortality by 12.6% (P=0.04) and hospital mortality by 15.1% (P=0.007) Complete bundle performance increased by 2 percentage points (SE, 0.9; P = .06) immediately after collaborative initiation. Each subsequent month was associated with an increase of 0.6 percentage points (SE, 0.2; P = .04). Performance rates increased significantly immediately after initiation for pain assessment (7.6% [SE, 2.0%], P = .002), sedation assessment (9.1% [SE, 3.7%], P = .02), and family engagement (7.8% [SE, 3%], P = .02) and then increased monthly at the same speed as the trend in the baseline period. P <0.05  Conclusion: These studies showed that the ABCDEF Bundle is associated with lower ICU and hospital mortality The first limitation is that the study involved observational studies, and residual confounding cannot be omitted as an explanation for the observed changes in bundle performance. Secondly, conclusions cannot be made on long-term sustainability despite ICUs demonstrating improvements during a 20-month period. Authors should use an experimental research design The language used should be simplified for easier understanding by all audience The article provides information on reducing the use of common potentially preventable complications (PPCs) in acute care hospitals, connected to my DPI project. The Central Line Bundle demonstrated a 19% reduction in complications, and the ABCDEF Bundle demonstrated a 21% reduction. The ABCDEF Bundle can be implemented in various hospitals across the United States with a focus on safety culture, defined as the degree to which a system is characterized by attention to safety in tasks, relationships, and attitudes. Fill in table Negro,A., Cabrini, L., Lembo, R., Monti, G., Dossi, M., Perduca, A., Colombo,S., Marazzi, M., Villa,G., Manara, D., Landoni, G., & Zangrillo, A. (2018). Early progressive mobilization in the intensive care unit with out dedicated personnel. Canadian Journal of Critical Care Nursing, 29(3), 26–31. https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=132043106&site=eds-live&scope=site DeMellow, J. M., Kim, T. Y., Romano, P. S., Drake, C., & Balas, M. C. (2020). Factors associated with ABCDE bundle adherence in critically ill adults requiring mechanical ventilation: An observational design. Intensive & Critical Care Nursing, 60. https://doi-org.lopes.idm.oclc.org/10.1016/j.iccn.2020.102873 https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=edselp&AN=S0964339720300768&site=eds-live&scope=site&custid=s8333196&groupid=main&profile=eds1 https://pubmed.ncbi.nlm.nih.gov/32414557/ The study aim at identifying factors associated with ABCDEF bundle adherence in critically ill patients during the first 96hours of ventilation. Observational using electronic health record data The study used 15 ICUs located in seven community hospitals in western United States The study also included 977 adult patients who were on mechanical ventilation for more than 24hours and admitted to an intensive care unit over the six months. Multiple regression analysis was used to examine factors contributing to bundle Adherence while adjusting for severity of illness, days on mechanical ventilation, hospital site and time elapsed. ABCDEF bundle adherence was higher in patients on mechanical ventilation for less than 48 hours (p=0.01), who received continuous sedation for less than 24 hours (p < 0.001), admitted from skilled nursing facilities (p<0.05), and over the course of the six-month study period (p < 0.01). Bundle adherence was significantly lower for Hispanic patients (p < 0.01). (p <0.05) The observational results from the data identified that modifiable factors improved team’s performance of the ABCDEF bundle in critically ill patients in need of mechanical ventilation. The study was restricted to EHR clinical data available hence managed to only evaluate assessment for pain, sedation, delirium, and mobility elements. The study did not use analgesic infusions as sedation to determine duration of sedation and adherence of awakening trials. The study was limited to the examination of the early 96hours on MV adherence to bundle by the care unit. There is need for openness in data sharing among the physicians to develop a complete system that can identify all the factors associated with ABCDEF bundle adherence in severely ill patients The article supports my DPI project since the article identifies the factors associated with ABCDEF bundle adherence in critically ill patients during the first 96 hours of ventilation. The article supports the results that modifiable factors improve team’s performance of the ABCDE bundle in critically ill patients in mechanical ventilation. Loberg, R. A., Smallheer, B. A., & Thompson, J. A. (2022). A quality improvement initiative to evaluate the effectiveness of the ABCDEF bundle on Sepsis outcomes. Critical Care Nursing Quarterly, 45(1), 42–53. https://doi-org.lopes.idm.oclc.org/10.1097/CNQ.0000000000000387 https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=cmedm&AN=34818297&site=eds-live&scope=site&custid=s8333196&groupid=main&profile=eds1 https://pubmed.ncbi.nlm.nih.gov/34818297/ The study aims to determine how quality improvement initiative can evaluate the effectiveness of the ABCDEF bundle elements to improve clinical outcomes Quality Improvement Secondary research through sampling Interventions was done in (609-bed) Midwest metropolitan hospital. Pre-implementation data were collected between January 2019 and March 2019. A pre/posttest design was used, and a convenience sample of all patients with sepsis admitted ABCDEF bundle elements and improve clinical outcomes. A significant improvement was seen in the completion of spontaneous awakening and breathing trials (P = .002), delirium assessment (P = .041), and early mobility (P = .000), which was associated with a reduction in mortality and 30-day readmission rates. (p <0.05 The study results indicated overall implementation of ABCDEF bundle in the setting resulted to enhanced care delivery and improved clinical outcomes. The QI initiative has problem with its generalizability Lower than desired rate with bundle elements was experienced The intervention was not designed as randomized controlled study but rather utilized as convenient sampling. There is need to provide nursing care education to healthcare workers to implement the ABCDEF bundle since its implementation has a direct impact on enhancing care giving and clinical outcomes. The government should support the implementation of the QI initiative to enhance quality care for patients. The article is relevant to my DPI project since it outlines the guidelines on how best ABCDEF bundle can be applied in nursing to improve clinical outcomes. Otusanya, O. T., Hsieh, S. J., Gong, M. N., & Gershengorn, H. B. (2021). Impact of ABCDE bundle implementation in the intensive care unit on specific patient costs. Journal of Intensive Care Medicine, 8850666211031813. https://doi-org.lopes.idm.oclc.org/10.1177/08850666211031813 https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=cmedm&AN=34286609&site=eds-live&scope=site&custid=s8333196&groupid=main&profile=eds1 https://pubmed.ncbi.nlm.nih.gov/34286609/#:~:text=Conclusions%3A%20Full%20ABCDE%20bundle%20implementation,increase%20in%20physical%20therapy%20costs. The study objective is to measure the impact of full versus partial ABCDE bundle implementation on specific cost centers and related resource utilization. Retrospective cohort study The study was conducted in two medical ICUs in Montefiore Health Systems The study also involved 472 mechanically ventilated patients admitted in the ICU between 1st January 2013 and 31st December 2013. Relative to the comparison ICU, implementation of the entire bundle in the intervention ICU was associated with a 27.3% (95% CI: 9.9%, 41.3%; P   0.004) decrease in total hospital laboratory costs and a 2,888.6% (95% CI: 77.9%, 50,113.2%; P   0.018) increase in total hospital physical therapy costs. Cost of total hospital medications, diagnostic radiology and respiratory therapy were unchanged. Relative to the comparison ICU, total hospital resource use decreased in the intervention ICU (incidence rate ratio [95% CI], laboratory: 0.68 [0.54, 0.87], P   0.002; diagnostic radiology: 0.75 [0.59, 0.96], P   0.020). (p <0.05) There was a relationship between ABCDE bundle implementation and the cost Relative to the comparison ICU, implementation of the entire bundle in the intervention resulted to a decrease of 27.3%in total hospital laboratory cost Total hospital resource use resource use decreased in the intervention ICU. The research data collection and analysis was only limited to two ICU centers. There is need for teamwork between professionals in nursing to fully implement ABCDE bundle intervention to increase ICU discharges and reduce total hospitalization cost Physicians also need conducive environment and support to fully implement ABCDE bundle in health centers The article supports my DPI project as it focuses on how fully implementation of ABCDE bundle significantly reduces hospital laboratory costs and the hospital resource use also decreased. van den Boogaard, M., Wassenaar, A., van Haren, F. M. P., Slooter, A. J. C., Jorens, P. G., van der Jagt, M., Simons, K. S., Egerod, I., Burry, L. D., Beishuizen, A., Pickkers, P., & Devlin, J. W. (2020). Influence of sedation on delirium recognition in critically ill patients: A multinational cohort study. Australian Critical Care, 33(5), 420–425. https://doi-org.lopes.idm.oclc.org/10.1016/j.aucc.2019.12.002 https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=145414398&site=eds-live&scope=site&custid=s8333196&groupid=main&profile=eds1 https://www.australiancriticalcare.com/article/S1036-7314(19)30131-6/pdf The study aim to determine the association between level of sedation and delirium occurrence in critically ill patients Observation of cohort study. Patients aged above 18years from multinational ICUs participated since ICU patients are at risk of developing outcome of interest and delirium. The study was a secondary analysis of a multinational prospective cohort study performed in 9 ICUs in different countries Patients were assessed either through CAM-ICU or ICDSC 1660 patients were involved in the study. Length of stay (ICU) (p <0.05) At a RASS of 0, assessment with the CAM-ICU (vs. the ICDSC) was associated with fewer positive delirium evaluations The influence of level of sedation on delirium assessment depends on whether the CAM-ICU or ICDSC is used The study based on comparison between sedation and delirium hence need to compare both CAM-ICU to ICDSC simultaneously and determine its impact on critically ill patients. There is need to compare the CAM-ICU and ICDSC simultaneously in sedated and non-sedated ICU patients There is need to offer training to nurses in intensive care units on how best sedation and delirium influence affects critically ill patients in ICU. The article is relevant since it focuses on determining the influence of sedation on delirium which aligns with DPI project as heath care personnel. Part 2 (3-09-2022) Chen, C., Cheng, A., Chou, W., Selvam, P., & Cheng, C. M. (2021). Outcome of improved care bundle in acute respiratory failure patients. Nursing in Critical Care, 26(5), 380–385. https://doi-org.lopes.idm.oclc.org/10.1111/nicc.12530 https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=152166449&site=eds-live&scope=site&

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