The Science Journal of the American Association for Respiratory Care

2002 OPEN FORUM Abstracts

MONITORING UNPLANNED EXTUBATIONS IN A PEDIATRIC INTENSIVE CARE UNIT: A QUALITY INDICATOR.

Brenda k.Batts, M..P.H.,RRT, Hughes Spalding Children’s Hospital, James McCrory, M.D. Pediatric Critical Care, Morehouse School of Medicine, Hughes Spalding Children’s Hospital, Ann George, M.H.A., Quality Utilization Specialist,Grady Health System

INTRODUCTION: Accidental extubations may lead to complications in critically ill infants and children on mechanical ventilatory support. These complications can cause increase morbidity and mortality. Many factors contribute to unplanned extubations in the pediatric population. Currently we track all unplanned extubations as measured by the total number of unplanned extubations relative to the total number of ventilator days. The national benchmark for this indicator is<5%. For the last year, the range in our Pediatric Unit is 1.5% to 2.0%. This is being monitored because it has high risk implications that could result in death. This indicator is also problem prone and can increase the cost of the patient care due to increased length of stay.

Methods: We used the FOCUS- PDCA methodology. We first organized a multi disciplinary team of staff members who knew the process. Members included: respiratory therapy staff and supervisor, nursing staff, physicians and quality management staff. After clarification of current knowledge and collection of information, we identified sources of process variations. Team members then planned the improvement, implemented the plan and began to collect the data. The PICU quality assurance monitoring form for unplanned extubations was used for continuous data collection and evaluation. Data collected included: (1) Time and place of the event. ( 2) How and who discovered? ( 3) Patient’s LOC, events preceding extubation. ( 4) Did patient develop problems and need reintubation?

RESULTS

TOPIC/ISSUE FINDING/% OF COMPLIANCE OUTCOME

Total#unplanned extubations

Total# Ventilator Days

2 =1.6%


125

Educate staff and increase awareness. Develop strategies to improve outcomes.
Discovered by Who? _=50% by R.T. staff.
_=50% by nursing staff.
Continue to monitor and document all unplanned extubations.
Was Ettube Securely Taped? 2/2=100% were securely taped. Review findings with staff.
Were Restraints Used? _=50% were restrained. Review restraint protocol with staff
Did patients require reintubation? 2/2 =100% required reintubation. Reintubated secondary to desaturations, bradycardia, and pain.
Events Preceding Extubations. A.Unobserved.
B. Patient turned head. C. Agitated and fighting.
D. Vomited and grabbed tube
Review findings with respiratory , nursing and physician staff.

Conclusions: We conclude that the level of restraint use, procedures, and tube fixation contributed to the incidences of accidental extubations in infants and children. Moreover, monitoring of unplanned extubation occurrences should be an ongoing quality indicator in pediatric intensive care units. We will continue to monitor and document all unplanned extubations.

OF-02-079

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