1. Sustaining Respiratory Therapist Engagement in ICU Liberation Tamra Kelly BS, RRT, Meg Blankinship MBA, BSRC, RRT, Alan Cubre MD, Kelly Switzler RRT, Latecia Hampel RRT, Tanya Kapitula RRT, Heidi Reams RRT, Tim Sammons RRT, Chris Chaney RPFT The presenter has no conflicts of interest. There was no research funding, sponsorship or research support for this work. Background The Society for Critical Care Medicine (SCCM) has developed a guideline for the management of pain, agitation, and delirium in patients in the Intensive Care Unit. This guideline was based on evidence that critically ill patients are at risk for development of delirium. The Respiratory Therapy departments in our hospital system implemented an interprofessional bundle approach to reduce this adverse event. Initially the Respiratory Therapists identified barriers including workload and productivity concerns, fear of patient discomfort and asynchrony, and fear of inadvertent extubation during awakening and mobility. Once those barriers were overcome with a variety of techniques, the department had to persistently ensure that the engagement of the staff was sustained. Methods Upon implementation of the ICU Liberation bundle work was done to overcome barriers and maintain staff engagement. To sustain the work, ongoing techniques were required to ensure bundle elements were performed daily as part of the standard work of the Respiratory Therapists. Interprofessional team education was provided to staff at the beginning of the project and the use of these skills was monitored during daily ICU rounds. We scheduled RT and nursing team leaders to monitor rounds to ensure the team utilized standardized order sets and procedures to promote best practices such as delirium assessments, correct medication selection, daily awakening and spontaneous breathing trials and early mobility. We tracked ventilator length of stay (LOS), ICU LOS, ICU mortality, 6-month post discharge mortality, ventilator LOS greater than 7 days, and all or nothing bundle compliance data. Results Four months into full implementation, daily rounds are occurring, standardized scales are used to assess delirium and sedation levels, daily SAT and SBT’s are being performed and patients who meet safety criteria are being mobilized. Patients are more awake and participating in ventilator weaning trials and mobilization. Ventilator LOS has decreased with no increase in re-intubation rate. 6-month post discharge mortality rates are reduced from 11.2% to 2.9%. Conclusion The ICU Liberation bundle is being sustained with improved clinical outcomes. Management, informal clinical leaders and staff worked together to remove barriers, maintain staff engagement which was critical to sustaining our work. Further study is needed to assess long term outcomes and compliance with the bundle. Data PDSA Model For Improvement Plan Sustain RT Engagement in ICU Liberation Do Engaged staff and physician champions Volunteers were trained on interprofessional team building use research Developed evidence based procedures and bundle Implemented interprofessional daily rounds Study Tracking ventilator LOS and reintubation rate Track compliance with bundle Act The process is evolving as we monitor our data and receive input from stakeholders Daily audits of rounding process for data collection and real time feedback to team for improvement