Prevention of Unplanned Extubation in PICU: Nurse-led Quality Improvement project

Author(s): Hazel Lyn Obina RN, Kathyrine Tayag RN, Hammad Almohileb RRT, Hakem Alomani MD*

Introduction: Unplanned extubation is a well-recognized health problem and frequent morbidity in PICU.

Method: Our SMART aim is to reduce the UPE rate to less than 1 per 100 ventilator days and sustain it for at least six months within 12 months. We chose the rate of UPE as an outcome measure. We chose Percentage of PICU staff who attended UPE training, Percentage of compliance to nurse assignment based on RAS, percentage of adherence to safety tag, Percentage of adherence to ETT fixation and completion of UPE case analysis form as process measures. We used PDSA as the main strategy to test the changes and implement multiple interventions.

Result: Over 32 months of the entire project period, we recorded 10 UPEs events. 80% of patients were one year old or less. 60% of UPEs were with uncuffed ETT, and 80% happened in the early morning between 00:00 and 12:00. 50% needed reintubation, and 80% were discharged. However, 20% died in PICU (2 patients). 3 PDSAs were rolled out during the project, and the rate of UPE decreased from 0.4 per 100 ventilation days in the year 2019 to 0.1 per 100 ventilation days in the year 2021 and was sustained for more than six months.

Conclusion: UPE can cause significant morbidity and/or mortality in PICU, and we can identify high-risk patients and the factors that contribute to such morbidity. The quality improvement project is an effective tool to decrease or prevent UPE events in PICU.

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