Reducing NICU Unplanned Extubations From Tube Dislodgement.

Area of Science:

• Neonatal Intensive Care Unit (NICU) quality improvement
• Patient safety initiatives in critical care
• Healthcare quality and safety research

Background:

• Unplanned extubations (UEs) are a common challenge in intensive care units (ICUs), leading to adverse patient outcomes.
• Reducing UEs is a critical goal for improving patient safety and care quality in neonatal and pediatric settings.
• Existing methods for UE reduction often require significant resources, limiting their applicability.

Purpose of the Study:

• To implement and evaluate low-cost, scalable interventions to reduce unplanned extubations (UEs) due to tube dislodgement in a level IV NICU.
• To assess the effectiveness of a quality improvement initiative using the Model for Improvement framework.
• To identify key interventions for sustained reduction of UEs in a critical care setting.

Main Methods:

• A multidisciplinary team utilized the Model for Improvement from January 2019 to July 2023.
• Sequential interventions focused on improving adherence to a modified UE care bundle.
• Data analysis employed statistical process control charts to monitor UE rates per 100 ventilator days.

Main Results:

• The rate of UEs decreased from a baseline of 2.3 to 0.6 per 100 ventilator days.
• Adherence to the UE care bundle exceeded 90% after December 2020.
• No endotracheal tube-related pressure injuries were reported, serving as a key balancing measure.

Conclusions:

• Sustained reduction in unplanned extubations was achieved through a multidisciplinary quality improvement approach.
• A UE care bundle, coupled with post-event debriefing guides, proved highly impactful.
• The implemented low-cost interventions are scalable to other NICUs and Pediatric Intensive Care Units (PICUs).