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A Structured Approach to Extubation in Mechanically Ventilated Rats
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Reducing Unplanned Extubations in the NICU Using Lean Methodology.

Bonnie M Powell1, Edeltraud Gilbert2, Teresa A Volsko3

  • 1Department of Respiratory Care, Akron Children's Hospital of the Mahoning Valley, Boardman, Ohio. bpowell2@chmca.org.

Respiratory Care
|December 1, 2016
PubMed
Summary
This summary is machine-generated.

A rapid-cycle quality improvement initiative significantly reduced unplanned extubations in a Neonatal Intensive Care Unit (NICU). This approach, using Plan-Do-Study-Act (PDSA), improved patient safety and care for intubated infants.

Keywords:
accidental extubationlean methodologyprocess improvementself-extubationunplanned device removalunplanned extubation

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Area of Science:

  • Neonatal care
  • Quality improvement in healthcare
  • Patient safety

Background:

  • Unplanned extubations in Neonatal Intensive Care Units (NICUs) pose risks for iatrogenic injury and patient safety events.
  • Lean methodology was implemented to decrease unplanned extubation rates in a Level 3b NICU.
  • A rapid-cycle Plan-Do-Study-Act (PDSA) initiative was hypothesized to effectively reduce these rates.

Purpose of the Study:

  • To evaluate the effectiveness of a rapid-cycle PDSA initiative in reducing unplanned extubations in a NICU.
  • To identify staff perceptions regarding the causes and impact of unplanned extubations.
  • To implement and assess targeted improvements to prevent extubations.

Main Methods:

  • Collected baseline unplanned extubation data from November 2012 to June 2014.
  • Utilized a 'voice of the customer' survey to gather staff perceptions on extubation causes.
  • Implemented six identified improvements in two phases, focusing on standardization of care, ETT management, and communication.

Main Results:

  • A statistically significant reduction in unplanned extubations per 100 intubated days, from 3.8 to 2.7 (P = .01).
  • A significant decrease in the total number of intubated days post-intervention (P < .001).
  • A 68% survey response rate indicated staff engagement and awareness.

Conclusions:

  • Staff initially underestimated the frequency of unplanned extubations but acknowledged the need for interventions.
  • The rapid-cycle PDSA approach proved effective in significantly lowering the rate of unplanned extubations.
  • Observed reductions in intubated days may be linked to practice changes spurred by the quality improvement initiative.