Barriers and Facilitators to ICU Liberation Bundle Implementation and Compliance

OBJECTIVES: The ICU Liberation bundle is a framework to help translate the Pain, Agitation, Delirium, Immobility, and Sleep Guidelines into clinical practice. Bundle performance has been shown to improve short- and long-term outcomes in critically ill patients. This article aims to: 1) describe the landscape of the ICU Liberation bundle in the wake of the COVID-19 pandemic; 2) identify barriers and facilitators to bundle implementation and compliance across ICUs; and 3) compare perceptions between ICU clinicians and leaders with respect to bundle priority, workflow integration, and facilitators and barriers that affect bundle compliance. DESIGN: In 2022, Society of Critical Care Medicine conducted an electronic survey of its members to assess the current state of ICU Liberation bundle implementation and compliance, to identify facilitators and barriers to bundle implementation. SETTING: Electronic survey. SUBJECTS: Clinicians and leaders involved in the care of critically ill patients. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 456 respondents comprised of ICU clinicians (n = 197) and leaders (n = 259) completed the survey. Clinicians were more familiar with the bundle and considered it a greater priority vs. leaders. Bundle compliance was significantly lower post-pandemic vs. pre-pandemic in both groups. A lack of leadership and staff buy-in were significant barriers affecting compliance of most bundle elements. Communication breakdown was a significant barrier affecting compliance of elements A and F, a lack of staffing was significant for element E, and a lack of staff education was significant for element B. Workflow integration strategies such as order sets, checklists/goal sheets, electronic health record integration, and one-on-one teaching facilitated bundle compliance across various bundle elements. Aligning the bundle with healthcare system strategic goals facilitated compliance across all bundle elements. CONCLUSIONS: This survey identifies facilitators and barriers to ICU Liberation bundle compliance and serves as a framework for interprofessional teams and leadership to promote bundle implementation and sustainability.