Reducing Unplanned Extubations in a Level IV Neonatal Intensive Care Unit Utilizing Quality Improvement Methodology

Area of Science:

• Neonatal Intensive Care Unit (NICU) Quality Improvement
• Patient Safety in Neonatal Care
• Adverse Events in Neonatal Medicine

Background:

• Unplanned extubations (UEs) are a frequent adverse event in neonatal patients, linked to increased morbidity.
• The study's level IV NICU had a high UE rate (1.33 events/100 ventilator days), exceeding benchmarks.
• A quality improvement (QI) initiative was launched to reduce the UE rate to 0.6 events/100 ventilator days.

Purpose of the Study:

• To decrease the rate of unplanned extubations (UEs) in a level IV NICU.
• To implement targeted interventions using a quality improvement framework.
• To align the NICU's UE rate with established patient safety benchmarks.

Main Methods:

• A pre-intervention (2020-2021) and post-intervention (2022-2023) comparison of UE events.
• Implementation of interventions via Plan-Do-Study-Act cycles, including huddles, leadership rounding, and standardized endotracheal tube securement.
• Monitoring UE rates and bundle adherence through Kamishibai cards and event analysis.

Main Results:

• UE events decreased from 100 (2020) and 87 (2021) to 48 (2022) and 35 (2023).
• A 65% reduction in annual UE events was observed when comparing 2023 to 2020.
• The UE rate shifted from 1.33 to 0.77 events/100 ventilator days, approaching the target.

Conclusions:

• Quality improvement methodologies effectively reduced UE events and rates in a level IV NICU.
• Standardized practices, interdisciplinary teamwork, and focused discussions on preventability were key to success.
• The interventions demonstrated the potential to significantly enhance patient safety in neonatal care.