Related Experiment Video
Updated: Aug 16, 2025
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Reducing paediatric unintended extubation: A standardized bundle approach
Lindsay F Underwood1, Sharon Norman1, Benjamin Orwoll2
1School of Nursing, Oregon Health & Science University, Portland, Oregon, USA.
Insights
Implementing the Solutions for Patient Safety (SPS) bundle significantly reduced unintended extubation (UE) rates in a pediatric intensive care unit (PICU). High adherence to this evidence-based bundle is key to preventing UE in pediatric patients.
Area of Science:
- Pediatric critical care medicine
- Quality improvement science
- Patient safety research
Background:
- Unintended extubation (UE) poses significant risks in pediatric intensive care units (PICUs), leading to increased length of stay and costs.
- The international benchmark for UE rates is less than 1 per 100 ventilator days.
- Solutions for Patient Safety (SPS) developed a bundle to reduce UE, targeting a rate of ≤0.95 per 100 ventilator days.
Purpose of the Study:
- To establish the baseline UE rate in a mixed medical/surgical PICU.
- To implement the SPS UE Bundle for prevention.
- To assess bundle adherence and its impact on UE rates.
Main Methods:
- Utilized the IHI Model for Improvement (Plan-Do-Study-Act) for bundle implementation and assessment.
- Standardized endotracheal tube management using the SPS UE Bundle.
- Monitored adherence via peer-to-peer audits and tracked UE rates using line charts.
Main Results:
- The baseline UE rate was 1.83 per 100 ventilator days.
- Post-implementation, the UE rate decreased to 0.38 per 100 ventilator days (p=0.027).
- Mean adherence to the SPS UE Bundle was 92%.
Conclusions:
- High adherence to the SPS UE Bundle can significantly reduce UE rates in PICU settings.
- This quality improvement initiative demonstrates the effectiveness of the SPS bundle in standardizing practice and improving patient safety.
- The findings support the widespread adoption of evidence-based bundles for preventing unintended extubation in pediatric populations.
Background:
Unintended extubation (UE) is a serious risk associated with endotracheal intubation. In the paediatric population, UE can lead to significant patient harm. On average, each UE increases ICU and hospital length of stay by 5.5 and 6.5 days respectively and costs an additional $36 000. The international benchmark rate of UE for quality analysis cited in the literature is <1 per 100 ventilator days. The United States organization Solutions for Patient Safety (SPS) developed and introduced a bundle to reduce UE with a goal of ≤0.95 per 100 ventilator days.
Aim:
The aim of this quality improvement project was to determine the baseline rate of UE in a 20-bed mixed medical/surgical PICU in the Pacific Northwest of the United States, implement the SPS bundle for UE prevention, and assess adherence to the bundle, and subsequent rate of UE.
Study Design:
The IHI Model for Improvement Plan-Do-Study-Act (PDSA) was used to guide the development, implementation, and assessment of the SPS UE Bundle standardizing the management of endotracheal tubes. Adherence to the bundle was measured through peer-to-peer audits. Rates of adherence and UE were monitored on line charts.
Results:
Baseline rate of UE was 1.83 per 100 ventilator days; 23 weeks post implementation of the bundle the rate of UE was reduced to 0.38 UE per 100 ventilator days, F(7, 9) = 4.685, p = 0.027. The mean bundle adherence was 92%.
Conclusions:
This quality improvement initiative confirms that high adherence to the SPS UE Bundle may significantly reduce rates of UE in PICU settings.
Relevance To Clinical Practice:
Use of the SPS evidence-based discrete UE bundle and high adherence to the bundle can standardize practise and may reduce unintended extubation in the paediatric population.
Related Concept Videos
01:24Endotracheal Tube Extubation
Procedure
Extubation removes the endotracheal tube (ETT) from the patient on mechanical ventilation. It requires a well-coordinated, multidisciplinary approach involving physicians, nurses, respiratory therapists, and other healthcare professionals....
01:17Endotracheal Intubation II: Nursing Management
1. Nursing Care of Patients Before Intubation
Before the endotracheal intubation procedure, nurses play an essential role in ensuring the process goes smoothly. The nurses must be familiar with intubation...
01:15Endotracheal Intubation I: Procedure
The ET tube comprises various components, including a standard adaptor to attach a bag-valve-mask (BVM) or ventilator, a cuff, a pilot balloon, and radiopaque markings along its length to measure the insertion distance. The tube sizes...
01:22Cardiopulmonary Resuscitation II: ACLS Airway Management
01:16Oxygen Delivering System II: Venturi Mask and Transtracheal Oxygen
Venturi Mask
The Venturi mask, named after the Venturi effect, is designed to deliver precise oxygen concentrations. It consists of a large tube with an oxygen inlet that narrows down, causing a pressure drop that pulls air in through adjustable side ports. The mask is a lightweight,...
01:30Cardiopulmonary Resuscitation V: Advanced Airway Management Techniques