title: The pain, agitation, and delirium care bundle: synergistic benefits of implementing the 2013 Pain, Agitation, and Delirium Guidelines in an integrated and interdisciplinary fashion.
abstract: OBJECTIVE
  In 2013, the American College of Critical Care Medicine published a revised version of the pain, agitation, and delirium guidelines. The guidelines included an ICU pain, agitation, and delirium care bundle designed to facilitate implementation of the pain, agitation, and delirium guidelines.
  
  
  METHODS
  Review article.
  
  
  METHODS
  Multispecialty critical care units.
  
  
  METHODS
  Adult ICU patients.
  
  
  METHODS
  This article describes: 1) the ICU pain, agitation, and delirium care bundle in more detail, linking pain, sedation/agitation, and delirium management in an integrated and interdisciplinary fashion; 2) pain, agitation, and delirium implementation strategies; and 3) the potential synergistic benefits of linking pain, agitation, and delirium management strategies to other evidence-based ICU practices, including spontaneous breathing trials, ICU early mobility programs, and ICU sleep hygiene programs, in order to improve ICU patient outcomes and to reduce costs of care.
  
  
  RESULTS
  Linking the ICU pain, agitation, and delirium management strategies with spontaneous awakening trials, spontaneous breathing trials, and early mobility and sleep hygiene programs is associated with significant improvements in ICU patient outcomes and reductions in their costs of care.
  
  
  CONCLUSIONS
  The 2013 ICU pain, agitation, and delirium guidelines provide critical care providers with an evidence-based, integrated, and interdisciplinary approach to managing pain, agitation/sedation, and delirium. The ICU pain, agitation, and delirium care bundle provides a framework for facilitating implementation of the pain, agitation, and delirium guidelines. Widespread implementation of the ICU pain, agitation, and delirium care bundle is likely to result in large-scale improvements in ICU patient outcomes and significant reductions in costs.
authors.affiliation: Department of Anesthesia, Stanford University School of Medicine, Stanford, CA, USA. barrj@stanford.edu
authors.forename: Juliana
authors.initials: J
authors.lastname: Barr
authors.forename: Pratik P
authors.initials: PP
authors.lastname: Pandharipande
mesh_terms: D000328:Adult; D003422:Critical Care / Q000379:methods* / Q000592:standards; D016638:Critical Illness; D003693:Delirium / Q000188:drug therapy* / Q000517:prevention & control; D019033:Delivery of Health Care, Integrated; D006801:Humans; D007362:Intensive Care Units; D033183:Interdisciplinary Communication; D017063:Outcome Assessment, Health Care; D059408:Pain Management; D017410:Practice Guidelines as Topic; D011595:Psychomotor Agitation / Q000188:drug therapy* / Q000517:prevention & control