Decreasing Unplanned Extubation Rates on an Adult Medical Intensive Care Unit

Area of Science:

• Critical Care Medicine
• Quality Improvement Science
• Patient Safety Research

Background:

• Unplanned extubation is a critical issue in intensive care units (ICUs), with existing literature focusing on prevalence and risk factors rather than prevention.
• High unplanned extubation rates necessitate the development of effective, reproducible interventions.

Purpose of the Study:

• To reduce the unplanned extubation rate in an adult medical ICU from 2.0 per 100 ventilator days to meet the internal benchmark.
• To implement and evaluate a quality improvement project for preventing unplanned extubations.

Main Methods:

• A quality improvement project was initiated, involving risk stratification of patients for unplanned extubation.
• Bundled nursing interventions were developed by an expert group based on literature and unit data.
• The effectiveness of interventions was assessed through continuous monitoring of unplanned extubation rates.

Main Results:

• The unplanned extubation rate decreased from 1.307 per 100 ventilator days in 2018 to 0.344 in 2023.
• A statistically significant reduction (P < .001) in unplanned extubation events was observed after project implementation.
• The quality improvement project demonstrated effectiveness in lowering unplanned extubation rates over time.

Conclusions:

• Integrating evidence-based interventions and fostering a safety culture substantially decreased unplanned extubation rates.
• Effective patient assessment and communication are crucial for preventing unplanned extubations.
• The project highlights the success of a systematic approach to reducing critical care complications.