Decreasing Unplanned Extubations in the NICU, an Ongoing Quality Improvement Project

Area of Science:

• Neonatal care
• Quality improvement in healthcare
• Patient safety

Background:

• Unplanned extubations (UEs) pose significant risks to neonates.
• The Neonatal Intensive Care Unit (NICU) at Lankenau Medical Center experienced a rise in UE rates, reaching 4.6 per 100 ventilator days in 2016.

Purpose of the Study:

• To decrease the incidence of unplanned extubations in intubated neonates.
• To improve patient outcomes and safety within the Level III NICU.

Main Methods:

• Implementation of a standardized care bundle for intubated infants.
• Quality improvement project focused on reducing UE rates.
• Continuous monitoring of UE rates for accountability.

Main Results:

• The standardized bundle successfully decreased the UE rate to below 2 per 100 ventilator days since 2018.
• Sustained reduction in UE rates achieved through ongoing monitoring.
• Demonstrated effectiveness of a standardized approach in a NICU setting.

Conclusions:

• A standardized care bundle is an effective strategy for reducing unplanned extubations in neonates.
• Continuous quality improvement and monitoring are crucial for maintaining low UE rates.
• The initiative highlights the importance of standardized protocols in enhancing neonatal patient safety.