The Science Journal of the American Association for Respiratory Care

2011 OPEN FORUM Abstracts

A MULTIFACETED QUALITY IMPROVEMENT APPROACH WAS ASSOCIATED WITH A DECREASED INCIDENCE OF UNPLANNED EXTUBATIONS AT KING FAHAD MEDICAL CITY.

Abdulmohsen M. AlAhmed1, Nasser A. Al Homoud1, Atallah M. Al Osaimi1, Mohammed A. AlTannir2, Muhammad Riaz2, Valary Zimmerman2; 1Respiratory Care Dept, King Fahad Medical City, Riyadh, Saudi Arabia; 2Research Centre, King Fahad Medical City, Riyadh, Saudi Arabia

Background: Unplanned extubations (UEX) are associated with increased morbidity and even mortality in critically ill patients. Objective: To implement a comprehensive, multifaceted quality improvement (QI) initiative that improves care management policies and guidelines, enhances and monitors their adherence, and decreases UEX in mechanically ventilated patients in ICU settings, targeting an international benchmark incidence of < 1 UEX per 100 ventilator days. Methods: The incidence of UEX in 9 critical care units at King Fahad Medical City (KFMC) was assessed in 2486 patients with a total of 17364 ventilator days. The study comprised 2 periods: 1) pre-intervention (1124 patients/7275 ventilator days; April to December 2009); and 2) post-intervention (1362 patients/10089 ventilator days; January to September 2010). The comprehensive QI program included practical and theoretical educational sessions implemented after a review and update of extant internal policies and guidelines, and expanded quality control monitoring of intubated patients to include additional relevant criteria. In addition, to assure a safer practice, exceptional care was delivered by requiring the presence of a specialized respiratory therapist during any mobilization of high risk patients; that is, those with known difficult intubation, high ventilatory settings, or morbid obesity. UEX data and information on possible risk factors related to: 1) the patient (acuity and level of sedation); 2) tube type and placement (assessed radiographically and by external position); 3) patient-tube interface (tying and/or taping procedure); and 4) staff-related factors (specific staff involved, activity at the time of the UEX) were also recorded. Results: UEX events decreased significantly from 180 (16% of patients) in the pre-intervention period to 56 (4.1% of patients) after implementing the new program ( p < 0.001). In addition, UEX incidence decreased significantly from 2.47 to 0.56 per 100 ventilator days (p < 0.001). Conclusion: A comprehensive educational and monitoring QI initiative to decrease UEX in mechanically ventilated ICU patients at KFMC was associated with a significant decrease in UEX. Sponsored Research - None