Abstract
Background:
In this quality improvement project, we examined whether two different frequencies for moving endotracheal tubes (ETT) in the intensive care unit setting resulted in different patient outcomes. The outcomes evaluated were skin breakdown or wound development resulting by ETT pressure injury.
Methods:
We collected data in two different medical ICUs, where in unit 1 ETT movement was scheduled to occur every 4 hours versus unit 2 where ETT movement was scheduled to occur every 2 hours. Respiratory therapists were scheduled to move ETT every 4 hours in both ICUs. In unit 2 the nursing staff was also scheduled to move the ETT 2 hours after the ETT was moved by the respiratory therapists. We only looked at data that was documented in our EMR. Our sample size (n) was 117 patients in unit 1 and 146 in unit 2. Patients were evaluated daily by respiratory therapists and nursing staff and three times weekly by the ICU wound nurse for any skin breakdown or wound development associated with the ETT.
Results:
The actual number of ETT movements documented in the EMR are shown in Table 1 below. We compared the number of EE movements with the T-test for the following data. The P value was 0.0019. This suggests that there was a statistically significant difference in the number of ETT movements that occurred between the two ICUs. The chi-square statistic is 0.1529. The P -value is 0.69. Hence the result is not significant. Meaning that both units’ data are similar in the context of skin breakdown and wound development Fisher Exact Test. Similarly, we can conclude the same by looking at the Fischer exact test. The Fisher exact test statistic value is 1. The result is not significant at P < .05.
Conclusions:
In conclusion, we can see that the frequency of skin breakdown or wound development was low in both ICUs. Moreover, more frequent movement of the ETT was not associated with better outcomes. However, we cannot be sure that compliance with moving ETT every 2 hours in unit 2 was achieved by the documented number of ETT movements recorded in unit 2.
Table 1
Unit 1
Unit 2
Mean
5.53
6.76
Std. Deviation
2.07
3.88
N
117
146
Chi-Square
No
Yes
Row Total
Unit 1
113
1
117
Unit 2
144
2
146
Column Totals
260
3
263
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