2006 OPEN FORUM Abstracts
POTENTIAL FACTORS AFFECTING UNPLANNED EXTUBATIONS
Bhavisha Y. Patel, BS, RRT, Joseph G. Dwyer, MAEd, RRT
The
Introduction:
Unplanned extubations occur
in almost every hospital that operates mechanical ventilators. Factors
affecting unplanned extubation events appear to be random at first glance, but
may prove to have common circumstances involved. The purpose of this abstract
is to determine if common factors exist and to identify possible actions to
reduce the frequency of unplanned extubations.
Method:
Unplanned extubation event information
was gathered using Patient Safety Net (PSN) online event reporting system
through University HealthSystem Consortium (UHC). PSN reports include the
following data: patient identifiers, demographics, date/time of event,
location, harm score, description of event and possible solutions. Additional
information was obtained through the Eclipsys® electronic medical documentation
system. Eclipsys data confirmed date/time/location of event, ventilator
parameter settings, weaning status, sedation administration level, restraint
use, and re-intubation post-event if indicated. The data was sorted and grouped
in the following categories as pertaining to the event: time of day, unit
location, ventilator weaning status (including sedation administration), use of
patient restraints, and ventilator settings and modes.
Results:
The following charts depict
numbers of reported unplanned extubations per ICU by ventilator mode, and by
timeframe of event occurrence.
Figure 1 displays unplanned
extubations related to the patients' mode of ventilation and the geographic
location at the time of the event. Figure 2 displays the time of day the events
occurred.
Conclusions:
Different philosophies are
employed in various ICUs and medical services regarding ventilation and weaning
strategies. Two ICUs in particular account for the majority of the events, but
with mixed results regarding mode of ventilation. Higher total frequencies of
events occur during spontaneous modes of ventilation, than during controlled
modes. The highest cluster of extubations in one ICU occurred more frequently
during controlled ventilation than spontaneous. Review of sedation protocols
and weaning guidelines are being evaluated for improvement.
Figure 2 displays three
timeframes of particular concern.Â
Eighteen (18) percent occurred from 0800-1000 which corresponds to
patient/health team rounds. Possible solutions could include having available
staff to see to immediate ventilation needs during this time. Two section of
the chart show fifteen (15) percent rates each from 0400-0600, and 1400-1600.
These time frames are associated with preparing patients for weaning, and then
for subsequent extubation. Accelerating the process, especially during
decreases in sedation levels may positively affect outcomes.