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Phased quality improvement interventions in reducing unplanned extubation in the neonatal ICU

Lookup NU author(s): Hannah Smith


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© 2020 Daedalus Enterprises.BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Publication metadata

Author(s): Nair V, Smith H

Publication type: Article

Publication status: Published

Journal: Respiratory Care

Year: 2020

Volume: 65

Issue: 10

Pages: 1511-1518

Online publication date: 14/04/2020

Acceptance date: 02/04/2016

ISSN (print): 0020-1324

ISSN (electronic): 1943-3654

Publisher: American Association for Respiratory Care


DOI: 10.4187/respcare.07643

PubMed id: 32291311


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