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ABCDE, change agent, clinical nurse specialist, delirium



  1. Reimers, Mallory MSN, RN, ACCNS-AG, CCRN
  2. Miller, Catherine MSN, RN, CCRN


Purpose/Objectives: The objective of this article is to address the role of the clinical nurse specialist (CNS) as a change agent in the implementation of a quality improvement program designed to prevent and assess delirium in ventilated patients at a community hospital.


Background: Delirium is both a common condition that is not well recognized among patients in the intensive care unit (ICU) setting and a challenging problem to manage. Patients remain ventilated in ICU settings longer, and often, physical/occupational therapy is not started until after the patient is extubated; thus, the risk for delirium is high.


Rationale: The quality improvement program was implemented to recognize and decrease delirium in the critically ill patient. An understanding of the role of the CNS as the change agent provides a reference for other CNSs. The CNS's roles of communication, collaboration, and education in fulfilling the core competencies across the spheres of patient, nurse, and system are crucial when implementing lasting change.


Description: A review of the literature supports the use of the ABCDE Bundle to better manage pain, sedation, and delirium. The CNS uses Kurt Lewin's 3-step model of change to implement the quality improvement program.


Outcome: A CNS successfully implemented the ABCDE Bundle in a community hospital to improve the prevention and assessment of delirium in the ICU patient.


Conclusion: This project demonstrates the CNS's ability to implement a program to aid in the prevention and assessment of delirium in critically ill patients in the ICU.


Implications: The CNS's involvement as the change agent to implement the ABCDE Bundle is effective in the prevention and assessment of delirium in ventilated patients. The goal of the ABCDE Bundle is to extubate patients sooner and transfer them out of the ICU faster.