The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

REDUCING THE RATE OF UNPLANNED EXTUBATIONS IN A LARGE PEDIATRIC MEDICAL CENTER

SCOTT PETTINICHI RRT, NPS, MED, JENNI RAAKE RRT, NPS, MBA, BRANDY SEGER RRT, BS, DEREK WHEELER MD, SUE POYNTER MD, ERIK MARTIN RN, MS

Background: Unplanned extubations (UEs) is a significant risk of mechanical ventilation resulting in poor patient outcomes. The Respiratory Care Division collaborated with the PICU and CICU to reduce the incidence of UEs in PICU from .79 UE per 100 days to less than .39 per 100 days, and from .71 UE per 100 days to less than .30 per 100 days in CICU. Key drivers identified to achieve change were: 1. Utilize best technique for securing endotracheal tubes (ETT). 2. Effective monitoring and verification of artificial airway placement in PICU and CICU. 3. Improve process for obtaining airway placement radiographs. Method: All Respiratory Care staff in PICU and CICU received training on a new technique for retaping ETTs. Signs were placed on the headboard of all patients with ETTs that detailed the size, placement and appropriate suction depth of the artificial airway. PICU and CICU staff were instructed to be present for all airway placement films to ensure consistency in the quality of airway placement films. Respiratory Care staff began a daily practice of reviewing airway placement radiographs. Results: Within a 6 month period the goal of a 50% reduction in our UE rate was met in PICU and CICU. Conclusion: The UE rate in the PICU decreased from .79/100 to .31/100. An 61% decrease.in UE. The UE rate in the CICU decreased from .71/100 to .10/100. An 86% decrease in UE. Incorporating best practices as well as utilizing a multidisciplinary approach is an excellent way to identify, brainstorm and solve performance improvement issues that are present. This collaborative approach resulted in a positive effect on patient outcomes. Sponsored Research - None

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