[Reducing the Unplanned Removal Rate of Endotracheal Tubes in the Pediatric Intensive Care Unit]

In 2012, the rate of unexpected removal of endotracheal tubes in our pediatric intensive unit was above the maximum target level of 0.28%. We designed a survey to identify the relevant difficulties faced by nurses in order to formulate viable solutions and reduce the removal rate. After assessing the findings of this survey, we concluded that the following represented the primary difficulties: use of incorrect endotracheal tube care standards, the inadequate sedation of patients, the incorrect cognition of care of nurses, and lack of in-service education and securing techniques.

After implementing quality improvements to overcome these difficulties, the rate of unexpected removal dropped dramatically to 0.57%.

Our quality improvement strategy included: designing a protocol and a checklist for securing endotracheal tubes, purchasing additional waterproof tape and restraint straps, establishing a standard protocol for sedation, producing an educational DVD, and continuing in-service education.

After implementation of the above measures, the rate of unexpected removal fell dramatically from 0.76% to 0.33%. Additionally, the completion-of-care rate for patients with endotracheal tubes rose significantly from 27.2% to 94.5%.

This project established a standard procedure for caring for endotracheal tube patients; improved communication among staff members; and reduced unexpected removal events.