Interventions to decrease tube, line, and drain removals in intensive care units: the FRATER study.

Area of Science:

• Critical Care Medicine
• Patient Safety
• Healthcare Quality Improvement

Background:

• Unintended tube, line, and drain removals (UTRs) pose a significant risk in intensive care units (ICUs).
• Identifying system factors contributing to UTRs is crucial for developing effective prevention strategies.
• Previous studies highlight the need for targeted interventions to reduce UTR incidence and associated complications.

Purpose of the Study:

• To determine the incidence and circumstances of UTRs in a medical ICU.
• To identify independent risk factors and protective factors associated with UTRs.
• To evaluate the effectiveness of interventions aimed at decreasing UTR occurrence.

Main Methods:

• Prospective interventional study conducted over two years in an 18-bed medical ICU.
• Data collection included patient demographics, clinical data, and UTR circumstances.
• Statistical analyses, including conditional logistic regression and segmented linear regression, were used to identify risk factors and intervention effects.

Main Results:

• The incidence of UTRs was 270 events per 10,000 patient days (9.6% of patients experienced at least one UTR).
• Risk factors included admission for coma and mechanical ventilation; higher SAPS II scores (>45) were protective.
• A 67.4% reduction in UTR rate was observed after the implementation of the first intervention.

Conclusions:

• UTRs are a frequent occurrence in the ICU setting.
• System factors significantly contribute to UTRs, emphasizing the need for systemic solutions.
• A continuous quality improvement program effectively reduces UTR rates in the ICU.