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Reducing paediatric unintended extubation: A standardized bundle approach.

Lindsay F Underwood1, Sharon Norman1, Benjamin Orwoll2

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Summary

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.

Keywords:
bundlepaediatricquality improvementunintended Extubation

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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.