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The impact PICU nursing expertise has on a child's unplanned extubation
Matthew Norridge1,2, Alison E While1
1King's College London, Florence Nightingale Faculty of Nursing and Midwifery, London, UK and Evelina London Children's Hospital, Guy's & Thomas' NHS Foundation Trust, London, UK.
Insights
This study found no link between nursing expertise and unplanned extubations in pediatric intensive care units (PICU). Higher patient occupancy was associated with more extubations, suggesting non-workforce factors need further investigation.
Area of Science:
- Pediatric Intensive Care
- Nursing Quality Improvement
- Patient Safety
Background:
- Unplanned extubations in Pediatric Intensive Care Units (PICUs) are critical quality indicators.
- While factors like sedation and unit activity negatively impact extubations, high nurse-patient ratios are linked to improved safety.
- Optimal nurse-patient ratios and the effect of nursing expertise on care quality remain unclear.
Purpose of the Study:
- To investigate the impact of nursing expertise on unplanned extubations in pediatric patients.
- To analyze the relationship between nurse staffing levels and adverse events in a PICU setting.
Main Methods:
- A single-center audit of adverse event and nurse workforce data from a UK tertiary PICU.
- Analysis of over 74,477 nurse allocations between 2006 and 2011.
- Focus on unplanned extubations as the primary adverse event of interest.
Main Results:
- 78 unplanned extubations occurred during the study period.
- Most unplanned extubations involved patients cared for by junior nurses.
- No significant relationship was found between nurse seniority/qualifications and extubations.
- Higher patient occupancy correlated with an increased incidence of unplanned extubations.
Conclusions:
- Nursing expertise and nurse-patient ratios did not show a relationship with unplanned extubations in this PICU.
- Further research is recommended to explore non-workforce factors, including endotracheal tube security, sedation, and unit activity.
- In PICUs with high nurse-patient ratios, non-workforce factors require further investigation regarding their impact on unplanned extubations.
Background:
Unplanned extubations in PICU are used as a measure of quality in clinical governance strategies. While many factors, such as sedation or unit activity, impact negatively on unplanned extubations, high nurse-patient ratios reduce adverse patient events and improve patient safety. However, optimal nurse-patient ratios and the impact of the level of nursing expertise on the quality of care are unknown.
Aim:
The study aimed to examine the impact of PICU nursing expertise on the unplanned extubations of children.
Design:
Audit and analysis of existing adverse event patient and nurse workforce data.
Method:
This single-centre study examined unplanned extubations at a mixed general and cardiac tertiary PICU in the UK. Routinely collected data from nursing and adverse incident databases were examined. The dataset included over 74,477 nurse allocations between August 2006 and April 2011. Unplanned extubations were the adverse event of interest.
Results:
A total of 78 unplanned extubations occurred between April 2006 and April 2011. The majority of unplanned extubations occurred when patients were looked after by junior nurses. The seniority of the nurse in-charge and the qualifications of the patient's nurse were not related to unplanned extubations. However, more unplanned extubations occurred at times of higher patient occupancy.
Conclusions:
Nursing expertise and nurse-patient ratios were not related to unplanned extubations in this study. Further research is needed to explore the non-workforce factors such as the securing of endotracheal tubes, sedation levels and unit activity and their relationship with adverse events.
Relevance To Clinical Practice:
In paediatric intensive care units where nurse-patient ratios are high, further investigation is needed to establish what impact non-workforce factors have on unplanned extubations.
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