Decreasing Unplanned Extubations in the Neonatal ICU

Area of Science:

• Neonatal Intensive Care Unit (NICU) Quality Improvement
• Patient Safety in Neonatal Care
• Mechanical Ventilation Management

Background:

• Unplanned extubation (UE) is a preventable adverse event in critically ill neonates.
• UEs can lead to serious complications, including cardiovascular resuscitation and respiratory compromise.
• Reducing UEs is crucial for improving outcomes in the NICU.

Purpose of the Study:

• To implement a quality improvement project to decrease unplanned extubations (UEs) in a level 4 NICU.
• To achieve a target rate of 1 UE per 100 ventilator days by October 2018.

Main Methods:

• Established a multidisciplinary task force (neonatologist, respiratory therapists, nurse educator).
• Tracked UE events and required electronic safety reports.
• Utilized Plan-Do-Study-Act (PDSA) cycles, including staff surveys, data collection tools, transfer protocols, securement device education, and daily tube retaping.

Main Results:

• Baseline UE rate was 9.9 UEs/100 ventilator days.
• Post-intervention, the UE rate decreased to 1.6 UEs/100 ventilator days (August 2018 to March 2019).
• This represents an 84% reduction in UE events.

Conclusions:

• A multidisciplinary quality improvement project effectively reduced UE rates in a level 4 NICU.
• PDSA cycles, education, and staff awareness were key components of the intervention.
• Ongoing surveillance and education are necessary to maintain the reduced UE rate.