Unplanned extubation in the intensive care unit: a quality-of-care concern

Area of Science:

• Critical Care Medicine
• Quality Improvement Science
• Patient Safety

Background:

• Unplanned extubation is a significant complication in intensive care units (ICUs).
• It poses risks including mortality and prolonged mechanical ventilation.
• Identifying incidence and risk factors is crucial for improving patient care.

Purpose of the Study:

• To determine the incidence of unplanned extubation in ICUs at Westchester County Medical Center.
• To evaluate the effectiveness of a quality improvement intervention aimed at reducing unplanned extubations.
• To identify risk factors associated with unplanned extubation.

Main Methods:

• A prospective quality improvement audit was conducted over a 1-month period.
• A corrective action plan involving education, risk assessment, and documentation was implemented.
• A 5-month follow-up review assessed the impact of the intervention on extubation rates.

Main Results:

• The initial incidence of unplanned extubation was 1 per 136 patient-ventilator days.
• Following the intervention, the rate decreased to 1 per 455 patient-ventilator days.
• Identified risk factors included patient anxiety, routine care interventions, and prior unplanned extubations.

Conclusions:

• Unplanned extubation is a quality-of-care concern in ICUs.
• A targeted quality improvement program can significantly reduce the incidence of unplanned extubation.
• While reducible, unplanned extubation cannot be entirely eliminated, emphasizing ongoing vigilance.