Electronic Health Record Integration

Epic and Oracle are are the first EHR services to incorporate the ICU Liberation Bundle into their EHR software and hence into clinicians’ workflows.

The Society of Critical Care Medicine (SCCM) ICU Liberation Committee has partnered with Epic and Oracle (formerly Cerner) to incorporate the ICU Liberation Bundle (A-F) for adult and pediatric patients into clinicians’ workflows. The bundle’s evidence-based practices enhance patient care in both adult and pediatric patient populations and are now at the fingertips of critical care clinicians.

How to Get Started

For Epic users:
Epic for Adult Patients
Epic for Pediatric Patients

For Oracle users:
Oracle for Adult and Pediatric Patients

Contact your institution’s administration or IT department to learn more.

Please note that customization or modification of the SCCM ICU Liberation build does not require permission from SCCM.

Essential Aspects of the ICU Liberation Bundle Build

The ICU Liberation Minimum Data Set serves as the foundation for this partnership with Epic and Oracle. While hospitals are allowed to customize the builds, it is crucial to note that certain aspects of the bundle are essential and are directly linked to SCCM’s definitions of ICU Liberation Bundle compliance.

To access the ICU Liberation Minimum Data Set, download the ICU Liberation Implementation Toolkit.

The following aspects of the SCCM ICU Liberation Bundle build are essential. These elements must remain unchanged to ensure alignment with SCCM’s standards for bundle compliance. Use of alternative assessment tools will not meet SCCM standards.

To ensure compliance with the ICU Liberation Bundle for adult patients, one or more of the following validated assessment tools in each domain must be used.

Pain assessment:

Critical-Care Pain Observation Tool (CPOT)
Behavioral Pain Scale (BPS)
Numeric rating scale (NRS)

Sedation assessment:

Richmond Agitation-Sedation Scale (RASS)
Sedation-Agitation Scale (SAS)

Delirium screening:

Confusion Assessment Method for the ICU (CAM-ICU)
Intensive Care Delirium Screening Checklist (ICDSC)

To ensure compliance with the ICU Liberation Bundle for pediatric patients, one or more of the following validated assessment tools in each domain must be used.

Pain assessment:

Numeric rating scale (NRS)
Revised Face, Legs, Activity, Cry, Consolability (r-FLACC)
Faces Pain Scale
Visual Analog Scale (VAS)
Oucher scale

Sedation assessment:

Richmond Agitation-Sedation Scale (RASS)
State Behavioral Scale (SBS)

Delirium screening:

Cornell Assessment of Pediatric Delirium (CAPD)
Pediatric CAM-ICU (pCAM-ICU) and Preschool CAM-ICU (psCAM-ICU)

Customizable Aspects of the ICU Liberation Build

The SCCM ICU Liberation Committee has included safety screen and outcome criteria for both the B and E elements of the bundle in the Epic and Oracle flowsheets. These criteria, based on robust evidence, serve as recommendations and can be customized without any impact on compliance, allowing institutions flexibility in adapting these criteria according to their unique best practices and protocols. The customizable aspects are:

SAT Safety Screen Exclusion Criteria
SAT Outcomes
SBT Safety Screen Exclusion Criteria
SBT Outcomes
Extubation Readiness Test Inclusion Criteria (pediatric patients only)
Early Mobility Safety Screen Exclusion Criteria

ICU Liberation Bundle Integration

This video is an overview of the ICU Liberation Bundle (A-F) Epic and Oracle builds. Experts share their invaluable experiences, insights, and best practices for successful bundle integration.

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The adoption of the ICU Liberation Bundle in EHR systems is a game-changer for improving the care of ICU patients. Following the evidence-based guidelines featured in the bundle has proven to reduce the likelihood of hospital death within seven days and cut readmissions in half, along with other improved patient outcomes. The challenge in ensuring the guidelines are adopted at all hospitals has been getting them in front of clinicians during the course of care. Inclusion of the bundle in an EHR is one of the most impactful ways to ensure they are implemented.

Patricia J. Posa,RN, BSN, MSA, CCRN-K, FAAN
Member since 1993

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