Abstract
Objective:
Unplanned extubation events (UPEs) in neonates are hazardous to patient safety. Our goal was to reduce UPE rate (#UPEs per 100 ventilator days) by 50% in 12 months at our 25-bed level III inborn unit.
Study Design:
Baseline data were gathered prospectively for 7 months. Three Plan-Do-Study-Act (PDSA) cycles targeting main causes of UPEs were developed over the next 20 months. Causes of UPEs were analyzed using Pareto charts; and a U control chart was created with QI Charts©. Standard rules for detecting special cause variation were applied.
Result:
Mean UPE rate decreased from 16.1 to 4.5 per 100 ventilator days, a 72% decrease, exceeding our goal. Analysis of U-chart demonstrated special cause variation, with eight consecutive points below the mean. Improvement was sustained throughout the study period.
Conclusion:
UPEs in neonates can be reduced with process standardization and frontline staff education, emphasizing vigilant endotracheal tube (ETT) maintenance.
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References
Loughead JL, Brennan RA, DeJulio P, Camposeo V, Wengert J, Cooke D . Reducing accidental extubation in neonoates. Jt Comm J Qual Patient Saf 2008; 34 (3): 164–170 125.
Veldman A, Trautschold T, Weib K, Fischer D, Bauer K . Characteristics and outcomes of unplanned extubation in ventilated preterm and term newborns on a neonatal intensive care unit. Paediatr Anaesth 2006; 16 (9): 968–973.
Carvalho FL, Mezzacappa MA, Calil R, Machado Hda C . Incidence and risk factors of accidental extubation in a neonatal intensive care unit. J Pediatr (Rio J) 2010; 86 (3): 189–195.
Lucas da Silva PS, Reis ME, Aguiar VE, Fonseca MC . Unplanned extubation in the neonatal ICU: A systematic review, critical appraisal, and evidence-based recommendations. Respir Care 2013; 58 (7): 1237–1245.
Lucas da Silva PS, de Carvalho WB . Unplanned extubation in pediatric critically ill patients: A systematic review and best practice recommendations. Pediatr Crit Care Med 2010; 11 (2): 287–294.
Barber JA . Unplanned extubation in the NICU. J Obstet Gynecol Neonatal Nurs 2013; 42: 233–238.
Merkel L, Beers K, Lewis MM, Stauffer J, Mujsce DJ, Kresch MJ . Reducing unplanned extubations in the NICU. Pediatrics 2014; 133 (5): e1367–e1372.
Provost LP, Murray S . The Health Care Data Guide: Learning from Data for Improvement. Jossey-Bass Publishers: San Francisco, CA, USA, 2011; 107–136.
Sharek PJ, Horbar JD, Mason W, Bisarya H, Thurm CW, Suresh G et al. Adverse events in the Neonatal Intensive Care Unit: Development, testing, and findings of a NICU-focused trigger tool to identify harm in North American NICUs. Pediatrics 2006; 118 (4): 1332–1340.
Gardner A, Hughes D, Cook R, Henson R, Osborne S, Gardner G . Best practice in stabilization of oral endotracheal tubes: a systematic review. Aust Crit Care 2005; 18 (4)158 160–165.
Lai M, Inglis GDT, Hose K, Jardine LA, Davies MW . Methods for securing endotracheal tubes in newborn infants. Cochrane Database Syst Rev 2014; 7: CD007805.
Meyers JM, Pinheiro J, Nelson MU . Unplanned extubation in NICU patients: are we speaking the same language? J Perinatol 2015; 35: 676–677.
Acknowledgements
We acknowledge all the nursing staff, neonatal fellows and neonatal nurse practitioners at Hahnemann University Hospital who contributed to the development and implementation of this quality improvement project.
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Fontánez-Nieves, T., Frost, M., Anday, E. et al. Prevention of unplanned extubations in neonates through process standardization. J Perinatol 36, 469–473 (2016). https://doi.org/10.1038/jp.2015.219
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DOI: https://doi.org/10.1038/jp.2015.219
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