The Science Journal of the American Association for Respiratory Care

2010 OPEN FORUM Abstracts

DECREASING UNPLANNED EXTUBATIONS IN A LEVEL IV NEONATAL INTENSIVE CARE UNIT

Annette E. Norman, Christopher Lynn; Pediatric Respiratory Care, Monroe Carell Jr. ChildrenÂ’s Hospital at Vanderbilt, Nashville, TN

BACKGROUND: Through data collection from electronic documentation and paper records, it was identified that a number of patients were experiencing unplanned extubations. Data was collected and analyzed to identify the circumstances surrounding any unplanned extubations. RCPs worked with multiple disciplines to develop a plan to address the issues. OBJECTIVE: To decrease the number of unplanned extubations in a level IV NICU. METHOD: All nursing and respiratory personnel were re-educated on a standardized procedure for securing endotracheal tubes with tape. In addition, a protocol was developed to provide specific steps that must be followed prior to any unscheduled patient extubations. A policy was implemented placing the RCP at the bedside prior to any intubation, extubation, or re-taping of an endotracheal tube. DATA: Data was collected on all unplanned extubations before, during and after practice changes. Data collected included: date, time of day, patient weight, cause, and need for re-intubation. The number of unplanned extubations was also plotted against the number of ventilator days. RESULTS: The number of unplanned extubations decreased from 45 in the 3rd quarter of 2009 to 12 in the 4th quarter of 2009. Total ventilator days were 1062 and 1443 for quarters 3 and 4, respectively. Potential advantages of decreasing unplanned extubations include: decreased risk of airway trauma, decreased use of sedation, decreased patient anxiety, and decreased VAP risk. CONCLUSIONS: Unplanned extubations could largely be avoided through education and the utilization of a pre-extubation checklist. FUTURE DIRECTION: Data revealed that 33% of patients in 2009, who self-extubated, did not require re-intubation. The development of a NICU ventilator weaning protocol should help liberate patients from the ventilator sooner, thus decreasing ventilator days and associated ventilator risks. Continuing education will be on-going regarding the proper procedure to follow prior to extubations and re-taping of the ETT. Monthly reports will be conveyed to staff showing progress on an on-going basis. Sponsored Research - None