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Recommended Citation
Ambrosio Y, Lombardo J, Bourque C. Living up to the challenge: Preventing unplanned extubations in the NICU. Quality Improvement podium presentation at Empowering Nursing Excellence: Recognizing the Value and Impact of Nurses, Advocate Health Midwest Region Nursing Research & Professional Development Conference 2023; November 15, 2023; virtual.
Presentation Notes
Quality Improvement podium presentation at Empowering Nursing Excellence: Recognizing the Value and Impact of Nurses, Advocate Health Midwest Region Nursing Research & Professional Development Conference 2023; November 15, 2023; virtual.
Abstract
Background
An unplanned extubation is a common adverse event for an intubated neonate that can lead to negative outcomes such as hypoxia, ventilator-associated pneumonia, extended hospital stays, and risk of injury. Prevention is a unique challenge in the NICU population due to small facial anatomy, increased ventilation days, and environmental factors.
Local Problem
A level 3 NICU experienced a total of five UEs in 2022 which equates to a rate of 3.59 per 100 ventilator days compared to a rate of 0 to 1 in previous years.
Method
A team consisting of the NICU APRN, Respiratory Educator and Neonatologists, performed a retrospective audit on each UE and analyzed the events to identify commonalities and opportunities. A multi-step quality improvement plan was developed based on the audit data and evidence-based literature on UEs. Implementation consisted of nursing and respiratory therapy staff education on the definition of an UE, performing and documenting a debrief after each event, reviewing airway security standard work, and participation in a high fidelity UE simulation led by a senior NICU nurse. Observations from the simulation revealed the need for further guidance on endotracheal tube securement. A measuring, cutting, and securement guide with videos was then created. The senior NICU nurse and a respiratory therapist met with each staff member to observe return-demonstrations. The team continued to review progress monthly with scheduled meetings.
Results/Conclusions
Since the implementation roll out in October and November 2022, the NICU has seen zero UEs in the last seven months.
Implications for Practice
Unplanned extubations in the NICU can be mitigated by using a team approach to identify key areas for improvement then creating a QI plan to target those gaps. Sustaining an UE rate of zero for the last seven months has allowed nurses to feel that the education they have participated in has made an impact at the bedside.
Document Type
Oral/Podium Presentation
Publication Date
11-15-2023
Living up to the challenge: Preventing unplanned extubations in the NICU
Background
An unplanned extubation is a common adverse event for an intubated neonate that can lead to negative outcomes such as hypoxia, ventilator-associated pneumonia, extended hospital stays, and risk of injury. Prevention is a unique challenge in the NICU population due to small facial anatomy, increased ventilation days, and environmental factors.
Local Problem
A level 3 NICU experienced a total of five UEs in 2022 which equates to a rate of 3.59 per 100 ventilator days compared to a rate of 0 to 1 in previous years.
Method
A team consisting of the NICU APRN, Respiratory Educator and Neonatologists, performed a retrospective audit on each UE and analyzed the events to identify commonalities and opportunities. A multi-step quality improvement plan was developed based on the audit data and evidence-based literature on UEs. Implementation consisted of nursing and respiratory therapy staff education on the definition of an UE, performing and documenting a debrief after each event, reviewing airway security standard work, and participation in a high fidelity UE simulation led by a senior NICU nurse. Observations from the simulation revealed the need for further guidance on endotracheal tube securement. A measuring, cutting, and securement guide with videos was then created. The senior NICU nurse and a respiratory therapist met with each staff member to observe return-demonstrations. The team continued to review progress monthly with scheduled meetings.
Results/Conclusions
Since the implementation roll out in October and November 2022, the NICU has seen zero UEs in the last seven months.
Implications for Practice
Unplanned extubations in the NICU can be mitigated by using a team approach to identify key areas for improvement then creating a QI plan to target those gaps. Sustaining an UE rate of zero for the last seven months has allowed nurses to feel that the education they have participated in has made an impact at the bedside.
Affiliations
Advocate Good Samaritan Hospital