Reducing unplanned extubations in the NICU following implementation of a standardized approach

Abstract

BACKGROUND: Unplanned extubations (UEs) have been associated with increased ventilator days, risk of infection, cardiopulmonary resuscitation, and resuscitation medication usage. The UE rate in our level 4 NICU is lower than the national average. Efforts to further reduce UE events at our institution led an interdisciplinary group to define steps to eliminate UEs. Steps included: (1) requiring at least 2 care providers at the bedside for movement of an intubated subject; (2) standardizing head and endotracheal tube (ETT) position; (3) defining a set methodology for ETT securing; (4) introducing a postoperative handoff to improve communication; and (5) implementing a post-UE assessment tool. METHODS: A quality improvement initiative reviewed subjects and compared UE rates before (January 2013 to December 2013) and after (January 2014 to December 2014) implementation of UE prevention guidelines. A de-identified data set was used for analysis. RESULTS: 67 UE events were identified with 46 UE events at baseline in 2013 compared with 21 in 2014 post-implementation. This amounted to a 64% decrease in total UE events (from 46 to 21) (P