Prevention of unplanned extubations in neonates through process standardization

Abstract

UPEs in neonates can be reduced with process standardization and frontline staff education, emphasizing vigilant endotracheal tube (ETT) maintenance.

Multidisciplinary interventions and continuous quality improvement to reduce unplanned extubation in adult intensive care units

“…This increase can be attributed to the hospital's having moved some experienced critical care nurses to support a newly set-up branch hospital, which decreased the quality of care in the ICU of our hospital's main branch ICU. Other studies [5,16–18] report similar findings in different populations. Fontanez-Nieves et al [16] reported a significant reduction of UE from 16.1 to 4.5/100 ventilator-days in neonates using the methods with 3 PDCA cycles over 20 months; Tripathi et al [5] reported a reduction in a pediatric ICU (PICU) from 3.55 to 2.59/100 intubation days after implementing a patient care policy targeting the risk factors, followed by extensive nursing and other personnel education over 12 months; Merkel et al [17] found a significant decrease in 3 years in the rate of UE in a neonatal intensive care unit (NICU) after bundles of potentially better practices had been implemented following sequential PDSA cycles; and Rachman and Mink [18] also reported that the effect of the quality improvement program to reduce UE had been successfully maintained even 9 years after implementation in the PICU.…”

“…Fontanez-Nieves et al [16] reported a significant reduction of UE from 16.1 to 4.5/100 ventilator-days in neonates using the methods with 3 PDCA cycles over 20 months; Tripathi et al [5] reported a reduction in a pediatric ICU (PICU) from 3.55 to 2.59/100 intubation days after implementing a patient care policy targeting the risk factors, followed by extensive nursing and other personnel education over 12 months; Merkel et al [17] found a significant decrease in 3 years in the rate of UE in a neonatal intensive care unit (NICU) after bundles of potentially better practices had been implemented following sequential PDSA cycles; and Rachman and Mink [18] also reported that the effect of the quality improvement program to reduce UE had been successfully maintained even 9 years after implementation in the PICU. In summary, our findings and those of other studies [5,16–18] indicate that a multidisciplinary quality improvement program can effectively reduce UE in the ICU, and the effect can be maintained and even improved 15 years after the sequential introduction of different interventions.…”

“…This finding is consistent with previous report in neonate that UE rate can be reduced with process standardization and frontline staff education, emphasizing vigilant ETT maintenance. [16] Tanios et al [23] reported on the different effects of various sedation strategies on UE in a mixed ICU. Their findings that a strategy of continuous sedation with a daily interruption of the sedative was associated with a lower rate of UE than was no sedation or intermittent sedation.…”

Effect of Anatomical and Developmental Factors on the Risk of Unplanned Extubation in Critically Ill Newborns

“…3,5 One of the largest studies to evaluate UEs in newborns included 304 patients ventilated for a total of 3,786 days over 5.5 years. In this cohort, 115 UEs occurred in 59 patients, and the reintubation rate was 66%, 2 similar to the reintubation rate of 69% in our cohort.…”

“…4 Since the 1970s, studies have reported high rates of UE in NICUs. 5–8 In a large, multicenter study using a NICU-specific trigger tool, UEs were the fourth most common adverse event in the NICU and the most common event specifically associated with mechanical ventilation. 9 Although the incidence and consequences of UEs are well-known, the epidemiologic factors associated with UEs in critically ill newborns, especially infants at greatest risk of UE, are poorly described making prospective evidence- based interventions difficult to determine.…”