Phased Quality Improvement Interventions in Reducing Unplanned Extubation in the Neonatal ICU

Unplanned extubation (UE) is a common adverse event and is an important measure of quality and patient safety in the neonatal ICU. It is well recognized that UEs occur more frequently in neonates than in any other group of ventilated patients. The objective of this study was to evaluate the effectiv...

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Bibliographic Details
Published in:Respiratory care 2020-10, Vol.65 (10), p.1511-1518
Main Authors: Nair, Vrinda, Smith, Helena
Format: Article
Language:English
Subjects:
Airway Extubation
Analysis
Humans
Infant, Newborn
Intensive Care Units, Neonatal
Intubation, Intratracheal - adverse effects
Medical research
Neonatal intensive care
Newborn infants
Patient care
Quality control
Quality Improvement
Retrospective Studies
Risk Factors
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Summary:Unplanned extubation (UE) is a common adverse event and is an important measure of quality and patient safety in the neonatal ICU. It is well recognized that UEs occur more frequently in neonates than in any other group of ventilated patients. The objective of this study was to evaluate the effectiveness of the quality improvement interventions in reducing the rates of UE in a tertiary neonatal ICU. A retrospective audit performed on ventilated infants showed a rate of 7.2 unplanned extubations per 100 ventilation days in a 12-month period (April 2016 to March 2017). We evaluated the common factors associated with UEs, with the primary reasons being loose fixation and providing care without assistance. We introduced sequential interventions focusing on better practices. Standardizing endotracheal tube fixation, continuous scrutiny of fixation through checks, 2-person technique for providing care, and adverse event reporting were a few of the important interventions. Rates of UE for each month were collected and analyzed. With interventions, UE rates reduced by 80% (from 7.2 per 100 ventilated days in the pre-implementation period to 1.4 per 100 ventilated days in the post-implementation period) in 12-18 months. Significant reductions in UE rates were achieved by implementing quality improvement interventions. It is important to analyze critical event rates continuously and for longer periods of time to determine the true change.
ISSN:0020-1324
1943-3654
DOI:10.4187/respcare.07643