2011 OPEN FORUM Abstracts
TEN YEAR MULTIDISCIPLINARY EXPERIENCE OF REDUCING ACCIDENTAL EXTUBATIONS IN A PICU.
David Thelander; Respiratory Care, Childrens Memorial Hospital, Chicago, IL
Background: Accidental Extubations (AE) are events which have the potential to lead to more serious consequences. Documenting the causes of AE's can lend insight into why they are occurring. The PICU Quality Assurance (QA) committee has been tracking AE's and their causes since 2000. The QA committee decides when interventions are necessary to help prevent AE's. Members of the QA committee include physicians, nurses, respiratory therapists, pharmacists and members of other disciplines. Method: A monitoring tool was developed in 2000 to assess the causes for AE's. This tool is filled out by the PICU respiratory specialist and includes a chart check, review of CXR's, and an interview of the bedside RN and RT. The results are presented quarterly at multidisciplinary QA meetings by the respiratory specialist. Trends are watched for, problems are identified and plans are developed to address the issues. Problems which accounted for 76% of the reasons for AE's included undersedation, bed space issues, security of ETT's and positioning of the ETT in the airway. Actions taken to address these issues included 1. Revision of sedation policies. 2. Inservicing RN's on sedation policies and the difference between sedation and pain medications. 3. Development of a competency to review taping of ETT's for the RT staff. 4. Training for Residents and Fellows to emphasize the need to review CXR's for proper ETT placement. 5. Informing PICU managers to assign bed spaces so that RN's could view patients at all times. Some interventions were initiated in 2000 and some in 2004 and 2006 after significant increases in AE's were observed. Results: The data for 2001-2010 was 36,729 ventilator days, 170 AE's, and .46 AE's per 100 ventilator days. The highest number of AE's was 23 in 2004, and the highest rate was .85 per 100 ventilator days in 2006. The AE rate per 100 ventilator days has steadily declined over the last 3 years. Starting in 2008, the rates have been .41, .39, and .21. Conclusions: Using a multidisciplinary approach has facilitated the AE rate to slowly decline over the past three years and helped the PICU keep the AE rate at an acceptable level. Having other disciplines involved in this process makes it easier to brainstorm, and come up with and carry out action plans to reduce the number of AE's and their potential complications. Sponsored Research - None