A new bundle of interventions to improve the care of critically ill patients receiving mechanical ventilation has been identified.1,2  This bundle incorporates performance and coordination of spontaneous awakening trials and spontaneous breathing trials; careful selection of sedatives; assessment, prevention, and management of delirium; and early exercise with progressive mobility.1,2  In collaboration with the Institute for Healthcare Improvement, and as a part of a critical care collaborative, our hospital had implemented many parts of the bundle, but early exercise and progressive mobility had not yet been incorporated into care. In this article, we share our process for literature review, appraisal, and synthesis along with protocol development. An evidence-based performance improvement (EBPI) model was used to plan, implement, and disseminate the change. High-fidelity human simulation boosted confidence and teamwork and also underscored important safety aspects before implementation. Unit...

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