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Related Concept Videos

Endotracheal Intubation II: Nursing Management01:17

Endotracheal Intubation II: Nursing Management

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Endotracheal intubation is a critical procedure that can be lifesaving for many patients with respiratory distress or failure. The role of nursing in managing endotracheal tubes is pivotal, as it involves pre-intubation preparation, assisting during the procedure, and post-extubation care.
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Endotracheal Tube Extubation01:24

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Endotracheal tube extubation is a critical procedure in weaning patients from mechanical ventilation. It involves physically removing the oral or nasal endotracheal (ET) tube, marking the final step in liberating a patient from ventilatory support.
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Nursing Clinical Information System01:27

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Nursing Clinical Information System (NCIS)
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Endotracheal Intubation I: Procedure01:15

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Implementation is the execution of the nursing care plan developed during the planning phase.
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Healthcare Associated Infections II: Preventive Measures01:22

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Essential infection prevention measures are based on the knowledge of the infection chain, the modes of transmission in healthcare settings, and the use of the best practices in all healthcare settings. Compulsory public reporting of healthcare-associated infection rates is needed to allow individuals and the community to make informed choices regarding selecting a healthcare facility.
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Synergizing Safety: A Customized Approach to Curtailing Unplanned Extubations through Shared Decision-making in the

Parvathy Krishnan1, Nilima Jawale1,2, Adam Sodikoff1

  • 1From the Department of Neonatal-Perinatal Medicine, Westchester Medical Center, and New York Medical College, Valhalla, N.Y.

Pediatric Quality & Safety
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Summary

Implementing shared decision-making among healthcare professionals significantly reduced unplanned extubation (UE) rates in the Neonatal Intensive Care Unit. This collaborative approach decreased UE by 48%, improving patient safety.

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Area of Science:

  • Neonatal Intensive Care Unit (NICU) patient safety
  • Quality Improvement in Healthcare
  • Interdisciplinary Healthcare Collaboration

Background:

  • Unplanned extubation (UE) is a critical patient safety concern in the Neonatal Intensive Care Unit (NICU).
  • A quality improvement initiative aimed to reduce UE rates by 10% through enhanced collaboration and shared decision-making.

Purpose of the Study:

  • To decrease the rate of unplanned extubation (UE) in the NICU.
  • To emphasize collaboration among nurses, respiratory therapists, and physicians.
  • To implement a shared decision-making model for patient care.

Main Methods:

  • Established an interdisciplinary Quality Improvement team (nurses, respiratory therapists, physicians).
  • Standardized the definition of UE and utilized apparent cause analysis for auditing.
  • Implemented interventions iteratively, reviewed monthly, and employed shared decision-making.

Main Results:

  • Baseline UE rate was 2.3 per 100 ventilator days.
  • Retaping, bedside care, and repositioning were primary causes of UE.
  • Achieved a 48% reduction in UE rate by December 2022, with special-cause variation by March 2023.

Conclusions:

  • Isolated education on reducing retaping was insufficient to lower UE rates.
  • Shared decision-making involving all healthcare professionals significantly reduced UE.
  • Systematic risk factor evaluation and collaborative practices are key to improving NICU safety.