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Pediatrics. 2019 May;143(5). pii: e20180897. doi: 10.1542/peds.2018-0897.

Reduction in Unintended Extubations in a Level IV Neonatal Intensive Care Unit.

Author information

1
Departments of Neonatology.
2
Virginia Hospital Center, Arlington, Virginia; and.
3
The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
4
Neonatal Intensive Care Unit, Children's National Health System, Washington, District of Columbia.
5
Respiratory Therapy, and.
6
Pediatric Critical Care Medicine and Pediatric Cardiology, and.
7
Departments of Neonatology, lsoghier@childrensnational.org.

Abstract

OBJECTIVES:

Unintended extubations (UEs) lead to significant morbidity in neonates. A quality improvement project was initiated in response to high rates in our level IV NICU. We targeted creating and sustaining UE rates below the published standard of 1 per 100 ventilator days.

METHODS:

This project spanned 4 time periods: baseline, epoch 1 (December 2010-May 2012), sustain, and epoch 2 (May 2015-December 2017) by using standard quality improvement methodology. Epoch 1 interventions included real-time analysis of UE events, standardization of taping, patient positioning and movement, accurate event reporting, and change in nomenclature. Epoch 2 interventions included reduction in daily chest radiographs (CXRs) and development of a high-risk tool. Patient and event characteristics were statistically compared across time points.

RESULTS:

Of the 612 UE events recorded over 10 years, 249 UEs occurred from May 2011 to 2017 involving 184 unique patients. UE rates decreased by 43% (from 1.75 to 0.99 per 100 ventilator days; epoch 1) and were sustained until a notable spike. Epoch 2 interventions led to a further 31% rate reduction. Single CXR use decreased by half. Median corrected gestational age at the time of an event was 35 weeks (interquartile range: 29-41). Seventy percent of infants experiencing an UE required reintubation, 29% had a previous event, and 9% had a code event.

CONCLUSIONS:

A decrease in UE below benchmarks can be achieved and sustained by standardization and mitigation interventions. This decline was also accompanied by a reduction in use of CXRs without increasing UE events.

PMID:
31028159
DOI:
10.1542/peds.2018-0897

Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

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