Development of ABCDEF Bundle for Improving Outcomes of ICU Patients

Document Type : Original Article


1 Students Research Center, Nursing Faulty, Baqiyatallah University of Medical Sciences, Tehran, Iran

2 Professor in Nursing Education, Atherosclerosis Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.

3 Professor in Nursing Education, Behavioral Sciences Research Center, Life style institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, IR Iran.

4 Professor in Nursing Education, Medicine, Quran and Hadith Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, IR Iran.

5 Assistant Professor of Anesthesiology, Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran



Introduction: The ICU liberation campaign helping improve quality of intensive care and reduces post-intensive care syndromes through the release of ABCDEF bundle, which utilizes an interprofessional approach. Evidence has shown barriers to proper bundle implementation (such as complexity and multiplicity of bundle interventions, limited bundle understanding by staff, poor interprofessional collaboration, shortage of staff) may play an important role. A multistage study was conducted to localize the ABCDEF bundle.
Methods: Firstly, the ABCDEF bundle was translated into Persian using the WHO protocol. The initial Persian translation was performed by both a nonmedical and medical individual. After combining and enhancing the translations, it was transformed into a checklist comprising 6 elements and 53 items, which were directed to experts to evaluate its face validity and qualitative content validity. After adjustment, the first expert panel validated the checklist, and a 5-point Likert rating system for assessment of importance, relevance, and feasibility were scored by them. Based on the results of descriptive analysis by SPSS, the experts' consensus led to elimination of one item and inclusion of other 52 items. Next, the second expert panel was held.
Results: The final ABCDEF bundle was prepared with 52 items and, the plan, the proper time and implement responsible, for its management is proposed.
Conclusions: Due to absence of the Iranian version of the ABCDEF bundle, our study provided a fluent and eloquent translation, to be both comprehensible and practical for the intensive care team members. The expert panel's opinion, adapted the bundle for implementation in the ICUs of Iran. We recommend that the localized ABCDEF bundle be implemented in specialized intensive fields (such as medical, surgical, trauma, etc). The contents of the bundle could not only be incorporated into ongoing training of staff, but also into the curriculum of undergraduates and medical residents.


Main Subjects

Volume 28, Issue 6
November and December 2023
Pages 975-983
  • Receive Date: 13 November 2023
  • Revise Date: 08 January 2024
  • Accept Date: 06 February 2024