Reducing Unplanned Extubations in the Neonatal Intensive Care Unit
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Purpose: The purpose of this quality improvement project was to explore the complications and risk factors associated with unplanned extubation (UE) in the neonatal population and to implement an UE bundle to reduce UEs.|Background: UE contribute to a significant increase in morbidity among critically ill neonates in the Neonatal Intensive Care Unit (NICU). Short term complications include acute respiratory and cardiovascular compromise that may require resuscitation and increase the risk of intraventricular hemorrhage, reintubation, and longer use of mechanical ventilation with increased risk of chronic lung disease. The occurrence of UEs in the NICU setting should be a preventable event with the target UE rate of 1 per 100 ventilator days. UEs occur frequently in the NICU and are a common adverse event.|Sample/Setting: This project was implemented in a 52-bed level III NICU in Colorado Springs, CO and included any patient intubated during the implementation period. Five patients were intubated during the implementation period and were included in data collection.|Methods: Factors associated with UE were analyzed and a 4-part UE bundle was implemented. Data collection included gestational age, weight, and duration of intubation.|Results: During a 11-week implementation period, 5 patients were intubated for a total of 7 ventilator days. There was no UE and all but 1 patient had standardized securement of the ETT. The average daily census was low compared to prior years and with lower patient acuity, assumed to be due to Covid-19, resulting in less than optimal data collection.|Conclusion: By implementing an UE bundle, UE was prevented during the project implementation period. However, due to a low census and low acuity, continued data collection is needed to determine true efficacy of the UE bundle.
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