Thomas Mwalimu Kahindi, Grace Githemo, Nickcy Mbuthia



Background. The Awakening, Breathing, Choice of analgesic and sedation, Delirium management and prevention and early Exercise/mobility (ABCDE) is evidenced based protocol associated with improved outcome of the critically ill patients. Fully implementation of this protocol optimizes the outcome of the mechanically ventilated patients.

Objective. The study explored the determinants of ABCDE bundle implementation by healthcare providers Coast general teaching and referral hospital critical care unit.

Methods. The study used descriptive design to explore the determinants that influence the ABCDE bundle implementation. Data collection was done through structured questionnaires in form of Likert scale. Study participants were selected using census sampling method. A total of (N=60) participants were involved in the study. Data was analysed using statistical package of social sciences (SPSS) version 25.

Results. A total of 60 questionnaires were collected from the participants. The results showed that female were the majority of the participants with 68.3% (n=41). Majority of the participants were between 30-39 age group with 38.3% (n=23). The results further revealed that nursing profession contributed the majority of the participants with 75% (n=45). The results also showed that most of the participants had diploma as their level of education with 65% (n=39). Furthermore, the results revealed that majority of the participants had experience of 1-2 years. Additionally, the results revealed that implementation of the bundle varied with 71.7% (n=43) implementing SAT, 66.7% (n=40) SBT, 63.3% (n=38) pain, 75% (n=45) sedation, 75% (n=45) delirium and 76% (n=46) early exercise/mobility. Bivariate analysis of healthcare providers’ factors showed that both knowledge and experience has relationship with ABCDE bundle implementation. Similarly bivariate analysis of the healthcare system factors revealed that workload, staffing, protocol availability and training are both significantly related to the implementation of the bundle. Multivariate analysis using logistic regression revealed that knowledge predicts bundle implementation with p=0.009, experience with p=0.049, workload with p=0.021, protocol with p=0.029, training with p=0.035 and staffing with p=0.007.

Conclusion.  ABCDE bundle implementation is influenced by both healthcare provider factors and healthcare system factors as revealed by this study.

Key words: Sedation, mechanically ventilation, spontaneous breathing trial, delirium.


Sedation, mechanically ventilation, spontaneous breathing trial, delirium.

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