ICU Liberation ABCDEF Bundle

Algorithm Steps

1. ▶

   Start

   ICU Patient - Daily Bundle Assessment

   Apply ABCDEF bundle elements daily

   1. ●

      Action

      A: Assess, Prevent, and Manage Pain

      Pain assessment is the first priority

      • Use validated pain scale (CPOT, BPS, NRS)
      • Assess q4h and PRN
      • Target: pain score <3 or comfortable
      • Analgesia-first approach before sedation
      • Multimodal analgesia when possible
      1. ●

         Action

         B: Both SAT and SBT

         Coordinated awakening and breathing trials

         • SAT: Daily sedation interruption
         • SBT: Spontaneous breathing trial
         • COORDINATE: SAT before SBT
         • Pass SAT → proceed to SBT
         • Reduces ventilator days and mortality
         1. ●

            Action

            C: Choice of Analgesia and Sedation

            Avoid benzodiazepines, target light sedation

            • Analgesia-first (opioids, adjuncts)
            • Sedation: Dexmedetomidine or Propofol
            • AVOID benzodiazepines (increased delirium)
            • Target RASS 0 to -2 (light sedation)
            • Daily sedation goals discussion
            1. ●

               Action

               D: Delirium - Assess, Prevent, Manage

               Screen every shift, use non-pharm interventions

               • CAM-ICU or ICDSC q8-12h
               • Identify and treat underlying causes
               • Non-pharmacologic interventions FIRST
               • Reorientation, sleep hygiene, early mobility
               • Limit deliriogenic medications
               1. ●

                  Action

                  E: Early Mobility and Exercise

                  Progressive mobility starting day 1

                  • Assess for contraindications daily
                  • Start: passive ROM, in-bed exercises
                  • Progress: sitting, standing, ambulation
                  • PT/OT consultation
                  • Safe to mobilize on vasopressors (stable doses)
                  • Reduces delirium, weakness, LOS
                  1. ●

                     Action

                     F: Family Engagement and Empowerment

                     Include family in care and decisions

                     • Open visitation policies when possible
                     • Family participation in rounds
                     • Communication and updates
                     • Family presence reduces delirium
                     • Support for family well-being
                     • Goals of care discussions
                     1. ◆

                        Decision

                        Bundle Elements Completed Today?

                        Document compliance with each element

                        1. ●

                           Action

                           Document Completion

                           Track bundle compliance

                           • Each element performed or contraindicated
                           • Document reasons if not done
                           • Track delirium-free, ventilator-free days
                           • QI metric for bundle compliance
                           1. ✓

                              Outcome

                              Daily Bundle Complete

                              Repeat daily throughout ICU stay

                        2. ●

                           Action

                           Address Barriers

                           Identify why elements not completed

                           • Clinical contraindication (document)
                           • Resource limitation (escalate)
                           • Knowledge gap (education)
                           • System issue (process improvement)