Abstract
Background:
Unplanned extubations (UE) can lead to increased mortality, morbidity, and length of stay. In 2016 UEs in PICU (0.41) and CVICU (0.34) met or exceeded the national average of 0.42 and 0.2 per 100 ventilator days in our hospital, leading to this project. In pediatric and cardiac intensive care units does endotracheal tube taping standardization, landmark documentation, and tape integrity assessments, compared to current practice decrease the rate of unplanned extubations?
Methods:
A collaborative, multidisciplinary UE Taskforce was formed. Solutions for Patient Safety initiatives shown to be effective in reducing UEs were adopted. A pre- and post-intervention data review was conducted, suggesting several areas for improvement. Three interventions adopted: a standardized 4-h tape integrity assessment; a single method of tube securement; and documenting measurement from an anatomical reference point via staff education.
Results:
Rates of UE per 100 ventilator days for April 2017-September 2017 were 0.463 for PICU and 0.595 for CVICU. After intervention of standardized tape method, staff education, and standardizing anatomical reference points the rate from October 2017-March 2018 for PICU per 100 ventilator days was 0.472 (2.068% change) and for CVICU was 0.664 (11.569% change).
Conclusions:
UE reduction was not achieved through standardized taping technique, establishing anatomical reference point, and tape integrity checks. Upon review of causative agents, patient repositioning and tube re-taping are commonplace. Future projects should include: longer data collection period, risk assessment scoring for high-risk patients, and additional support clinician during high-risk procedures to maintain airway. These suggestions are consistent with new Solutions for Patient Safety recommendations.
Disclosures:
None.
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