Reporting unplanned extubation

Between 1995 and 2002 seven clinical audits were undertaken in consecutive periods over twelve months to determine the frequency and risk factors associated with reported unplanned extubation (UE) within a 22-bed general and surgical Intensive Care Unit (ICU). Nursing and medical staff provided information on the patient's age, diagnosis, mental status, precipitating causes and investigations/treatment ordered. Following the first audit, modifications were made to include anonymous reporting. Additional information was also obtained on the patient's position, sedation regimen, method of endotracheal tube (ETT) placement and the use of physical restraints. A clinical indicator was established to monitor the UE incidence based as a rate of UE per 100 patients. Audit results were between 1.06% and 4.86% with an aggregate rate from 1995 to 2002 of 2.6%. This rate compares favourably with the range of 2.8-22.5% reported in the literature. Over the survey periods, 28-60% of patients were assessed as being confused or agitated, 47-67% restrained and 53-70% sedated. The UE reported rate initially increased when anonymous reporting was introduced from 1.06% to 4.86%. Unplanned extubation incidence subsequently decreased in Surgical ICU following the introduction of clinical pathways, early weaning and nurse led extubation. Monitoring UE in ICU provides important information on the quality of care. We would recommend a system of anonymous reporting to more freely reflect incidence.