Decreasing the Rate of Unplanned Extubation in Neonates in the Neonatal Intensive Care Unit

Bheru Gandhi, Isa Baruah, Suzanne Iniguez, Rebecca Schiff, Lindsy Nicklaus, Michael Speer


Aim: To reduce the unplanned extubation (UE) rate in neonates in the neonatal intensive care unit (NICU) by 20% from fiscal year (FY) 2015 to FY 2016 and sustain that decrease through FY 2017.

Materials and Methods: A multidisciplinary work group developed a classification system for causes of UEs based on post-UE event debriefings in the NICU from February 1, 2016, through September 30, 2016. Based on this classification scheme, targeted interventions were designed and sequentially implemented. Three interventions implemented were (1) an algorithm to address patients with questionable UE; (2) increasing frequency of staff assessment of endotracheal tube (ETT) depth; and (3) high-risk protocols to address patient–nurse interaction. The UE rate/100 ventilator days (VDs) in FYs 2016 and 2017 was compared with baseline data from FY 2014 and 2015 using a statistical process control chart.

Results: The UE rate/100 VDs in FY 2016 was 1.74 compared with a rate of 2.93 in FY 2015. This represented a 41% decrease in the UE rate/100 VDs. This improvement was sustained through FY 2017, where the UE rate was 1.03, which represented an additional 41% decrease compared with FY 2016. In total, there was a 65% decrease in the UE rate from FY 2015 to FY 2017. The highest ranked factor contributing to UEs was ETT depth.

Conclusions: Staff training and application of interventions targeted at contributory factors identified through mini-root cause analysis of UEs successfully reduced the UE rate.

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