The Science Journal of the American Association for Respiratory Care

2012 OPEN FORUM Abstracts

REDUCING UNPLANNED EXTUBATIONS WITH CONSISTENCY AND COLLABORATION.

Matthew S. Pavlichko1,2, Jennifer Seisler2, Meriam Yu2, Sharon Gambler2, David Sorrentino2; 1Respiratory Care Services, The Reading Hospital and Medical Center, West Reading, PA; 2NICU, The Reading Hospital and Medical Center, West Reading, PA

Background: Unplanned extubations plague the ventilated infant for many inherent reasons and create a patient safety concern. Lack of dentition, poor skin integrity, and uncuffed endotracheal tubes create problems not observed in adult mechanical ventilation. In the calendar year of 2011, it was perceived and noted that the NICU of The Reading Hospital and Medical Center had a spike in unplanned extubations. Method: A multidisciplinary approach was used to create an action plan which included representation from respiratory therapy, nursing, and neonatology. In September of 2011, historical data was collected specifically looking at reason for reintubation being unplanned extubations to quantify the perception. With a marked increase proven, the team created the action plan with special attention in maintaining skin integrity. The action plan was two parted: consistent ETT securing using the STABLE technique with a hydrocolloid barrier and waterproof, occlusive tape; and two clinicians at the bedside when moving and positioning the infant. Education to the entire NICU staff on the new policy was performed in December, 2011. Data was continually collected after the new process was in place. The goal of the intervention was to decrease unplanned extubations to 2 per 100 ventilator days. Results: Data displayed an average unplanned extubation rate of 5.36/100 ventilator days, with a monthly high of 14/100 from April to September, 2011. When data collection began, a marked decrease was noted. This appears to be the effect of clinicianÂ’s awareness of leadership focus on the solution. After education was performed and consistency established, unplanned extubations were maintained below the benchmark goal (actual 0.67/100). No skin breakdown was attributed to the securing technique. Conclusion: This quality improvement project was proven successful using the mentioned taping technique along with Respiratory Therapy and Nursing collaboration. Specific taping techniques were not evaluated in this study but the consistency of the procedure allowed for proper evaluation. We speculate that reducing unplanned extubations leads to improved ventilator outcomes and patient safety. Sponsorship: None Sponsored Research - None