1019: BARRIERS TO IMPLEMENTATION OF ICU LIBERATION BUNDLE IN LOW-MIDDLE-INCOME COUNTRIES

Introduction: The successful implementation of the ABCDEF bundle requires multidisciplinary coordination, leadership support, and adequate resources. Low-middle income countries (LMICs) face unique challenges including resource constraints and staffing shortages, but studies evaluating these barriers are scarce. This study aimed to identify the barriers to ABCDEF bundle implementation as perceived by LMIC healthcare providers.Methods: Using a cross-sectional survey, potential barriers were assessed by clinicians either currently working or worked in Africa, Asia, and Central America in the past, including lack of funds/equipment, nurse and allied health staff shortages, insufficient education/training, team-communication breakdowns, unit culture/staff resistance, limited leadership buy-in, and time-burden workflows, including others with space for free text. Ratings of top 3 selected were considered high-impact barriers.Results: A total of 370 participants completed the entire survey The high impact identified were resource constraints and human resource shortages. Nearly half (47%) of respondents identified lack of funds or equipment as a high-impact barrier. An identical 46% flagged shortages of nursing and allied health staff, while 45% cited insufficient education and training. Team communication breakdowns were also prominent, with 41% rating them as high-impact. A second barriers included unit culture or staff resistance (33%), limited leadership buy-in (30%), and workflow-related time burdens (26%). Interestingly, nearly one in five respondents perceived leadership engagement and workflow constraints as barrier, suggesting variability in institutional support. Qualitative comments highlighted specific challenges such as lack of mobility aids, cultural hesitancy to involve families in care, and limited access to validated delirium screening tools.Conclusions: Our findings highlight resource limitations and staff shortages as critical barriers in LMICs. Organizational culture and poor communication further impede adoption, while a lack of leadership engagement usually prevents the allocation of resources.