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Barriers and Facilitators to ICU Liberation Bundle Implementation and Compliance
Payal K Gurnani1, Erika L Setliff2, Samer Abu-Sultaneh3
1Department of Pharmacy, Houston Methodist Hospital, Houston, TX.
Critical Care Explorations
|June 9, 2026
Summary
ICU Liberation bundle compliance decreased post-pandemic due to barriers like lack of buy-in and communication. Strategies such as EHR integration and aligning with system goals can improve implementation and sustainability.
Area of Science:
- Critical Care Medicine
- Healthcare Quality Improvement
- Patient Safety
Background:
- The ICU Liberation bundle translates evidence-based guidelines into practice for critically ill patients.
- Bundle implementation has been linked to improved patient outcomes.
- The COVID-19 pandemic impacted healthcare delivery and may have affected bundle compliance.
Purpose of the Study:
- To describe the current state of the ICU Liberation bundle post-pandemic.
- To identify barriers and facilitators to bundle implementation and compliance.
- To compare clinician and leader perceptions regarding the bundle's priority and integration.
Main Methods:
- An electronic survey was conducted in 2022 among Society of Critical Care Medicine members.
- The survey assessed ICU Liberation bundle implementation, compliance, and associated factors.
- Respondents included ICU clinicians and leaders involved in critical care.
Main Results:
- Bundle compliance was lower post-pandemic compared to pre-pandemic.
- Lack of leadership/staff buy-in, communication issues, staffing shortages, and inadequate education were key barriers.
- Workflow integration strategies and alignment with healthcare system goals facilitated compliance.
Conclusions:
- The survey highlights critical facilitators and barriers to ICU Liberation bundle compliance.
- This understanding can guide interprofessional teams and leadership in promoting bundle implementation and sustainability.
- Addressing identified barriers is crucial for optimizing care for critically ill patients.
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