@article {Tripathi1105, author = {Sandeep Tripathi and Denise J Nunez and Chaavi Katyal and H Michael Ushay}, title = {Plan to Have No Unplanned: A Collaborative, Hospital-Based Quality-Improvement Project to Reduce the Rate of Unplanned Extubations in the Pediatric ICU}, volume = {60}, number = {8}, pages = {1105--1112}, year = {2015}, doi = {10.4187/respcare.03984}, publisher = {Respiratory Care}, abstract = {BACKGROUND: Although under-reported and understudied, unplanned extubations carry a significant risk of patient harm and even death. They are an important yardstick of quality control of care of intubated patients in the ICU. A unit-based risk assessment and multidisciplinary approach is required to decrease the incidence of unplanned extubations.METHODS: As part of a quality-improvement initiative of Children{\textquoteright}s Hospital at Montefiore, all planned and unplanned extubations in a multidisciplinary 20-bed pediatric ICU were evaluated over a 12-month period (January to December 2010). At the end of 6 months, an interim analysis was performed, and high-risk patient groups and patient care factors were identified. These factors were targeted in the second phase of the project.RESULTS: Over this period, there were a total of 267 extubations, of which 231 (87\%) were planned extubations and 36 (13\%) were unplanned. A patient care policy targeting the risk factors was instituted, along with extensive nursing and other personnel education in the second phase. As a result of this intervention, the unplanned extubation rate in the pediatric ICU decreased from 3.55 to 2.59/100 intubation days. All subjects who had an unplanned extubation during nursing procedures or transport required re-intubation, whereas none of the unplanned extubations during ventilator weaning required re-intubation.CONCLUSIONS: A targeted approach based on unit-specific risk factors is most effective in quality-improvement projects. A specific policy for sedation and weaning can be very helpful in managing intubated patients and preventing unintended harm.}, issn = {0020-1324}, URL = {https://rc.rcjournal.com/content/60/8/1105}, eprint = {https://rc.rcjournal.com/content/60/8/1105.full.pdf}, journal = {Respiratory Care} }