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Research ArticleOriginal Research

Phased Quality Improvement Interventions in Reducing Unplanned Extubation in the Neonatal ICU

Vrinda Nair and Helena Smith
Respiratory Care October 2020, 65 (10) 1511-1518; DOI: https://doi.org/10.4187/respcare.07643
Vrinda Nair
South Tees National Health Service Trust, Middlesbrough, United Kingdom.
Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom.
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  • For correspondence: [email protected]
Helena Smith
South Tees National Health Service Trust, Middlesbrough, United Kingdom.
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Abstract

BACKGROUND: Unplanned extubation (UE) is a common adverse event and is an important measure of quality and patient safety in the neonatal ICU. It is well recognized that UEs occur more frequently in neonates than in any other group of ventilated patients. The objective of this study was to evaluate the effectiveness of the quality improvement interventions in reducing the rates of UE in a tertiary neonatal ICU.

METHODS: A retrospective audit performed on ventilated infants showed a rate of 7.2 unplanned extubations per 100 ventilation days in a 12-month period (April 2016 to March 2017). We evaluated the common factors associated with UEs, with the primary reasons being loose fixation and providing care without assistance. We introduced sequential interventions focusing on better practices. Standardizing endotracheal tube fixation, continuous scrutiny of fixation through checks, 2-person technique for providing care, and adverse event reporting were a few of the important interventions. Rates of UE for each month were collected and analyzed.

RESULTS: With interventions, UE rates reduced by 80% (from 7.2 per 100 ventilated days in the pre-implementation period to 1.4 per 100 ventilated days in the post-implementation period) in 12–18 months.

CONCLUSIONS: Significant reductions in UE rates were achieved by implementing quality improvement interventions. It is important to analyze critical event rates continuously and for longer periods of time to determine the true change.

  • cardiopulmonary resuscitation
  • endotracheal tube
  • neonatal intensive care
  • quality improvement
  • unplanned extubation
  • ventilation

Footnotes

  • Correspondence: Vrinda Nair MD FRCPCH (UK), Neonatal Intensive Care Unit, James Cook University Hospital, Marton Road, Middlesbrough, United Kingdom, TS4 3BW. E-mail: vrinda.nair1{at}nhs.net
  • Dr Nair and Ms Smith presented a version of this paper at the 25th REaSoN Annual Neonatal Conference, held June 30 to July 2, 2019, in Warwick, United Kingdom. A version of this paper was also presented as a poster at the Pediatric Academic Society conference, held April 24 to May 1, 2019, in Baltimore, Maryland.

  • The authors have disclosed no conflicts of interest.

  • Copyright © 2020 by Daedalus Enterprises
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Respiratory Care: 65 (10)
Respiratory Care
Vol. 65, Issue 10
1 Oct 2020
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Phased Quality Improvement Interventions in Reducing Unplanned Extubation in the Neonatal ICU
Vrinda Nair, Helena Smith
Respiratory Care Oct 2020, 65 (10) 1511-1518; DOI: 10.4187/respcare.07643

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Phased Quality Improvement Interventions in Reducing Unplanned Extubation in the Neonatal ICU
Vrinda Nair, Helena Smith
Respiratory Care Oct 2020, 65 (10) 1511-1518; DOI: 10.4187/respcare.07643
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Keywords

  • cardiopulmonary resuscitation
  • endotracheal tube
  • neonatal intensive care
  • quality improvement
  • unplanned extubation
  • ventilation

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