• Michele C Balas, Brenda T Pun, Chris Pasero, Heidi J Engel, Christiane Perme, Cheryl L Esbrook, Tamra Kelly, Ken D Hargett, Patricia J Posa, Juliana Barr, John W Devlin, Alexandra Morse, Barnes-Daly Mary Ann MA Mary Ann Barnes-Daly is a clinical performance improvement consultant, Sutter Health., Kathleen A Puntillo, J Matthew Aldrich, William D Schweickert, Lori Harmon, Diane G Byrum, Shannon S Carson, E Wesley Ely, and Joanna L Stollings.
• Michele Balas is an associate professor, Center of Excellence in Critical and Complex Care, College of Nursing, and a nurse scientist, Wexner Medical Center, The Ohio State University, Columbus. balas.17@osu.edu.
• Crit Care Nurse. 2019 Feb 1; 39 (1): 46-60.

AbstractAlthough growing evidence supports the safety and effectiveness of the ABCDEF bundle (A, assess, prevent, and manage pain; B, both spontaneous awakening and spontaneous breathing trials; C, choice of analgesic and sedation; D, delirium: assess, prevent, and manage; E, early mobility and exercise; and F, family engagement and empowerment), intensive care unit providers often struggle with how to reliably and consistently incorporate this interprofessional, evidence-based intervention into everyday clinical practice. Recently, the Society of Critical Care Medicine completed the ICU Liberation ABCDEF Bundle Improvement Collaborative, a 20-month, nationwide, multicenter quality improvement initiative that formalized dissemination and implementation strategies and tracked key performance metrics to overcome barriers to ABCDEF bundle adoption. The purpose of this article is to discuss some of the most challenging implementation issues that Collaborative teams experienced, and to provide some practical advice from leading experts on ways to overcome these barriers.©2019 American Association of Critical-Care Nurses.

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