Saud Almugaiteeb, MBA
Respiratory Therapist
King Abdullah Bin Abdulaziz university hospital, United States
Disclosure information not submitted.
Abdullah Alzahrani, MS
Respiratory Therapist
King Abdullah Bin Abdulaziz university hospital, United States
Disclosure information not submitted.
Fabian Lora, MSRC, RRT-NPS, C-NPT
Respiratory Therapist
Loma Linda University, United States
Disclosure information not submitted.
David Lopez, Ed.D, RRT
Associate Professor
Loma Linda University, United States
Disclosure information not submitted.
Abdullah Alismail, PhD, RRT, , FCCP
Assistant Professor
Loma Linda University, United States
Disclosure information not submitted.
Title: Decreasing Incidents of Unplanned Extubation in Neonatal ICU: A Quality Improvement Project
Introduction: Unplanned extubation (UE) of mechanically ventilated neonates is an adverse event that carries serious harm and can contribute to significant morbidity and mortality. A suggested target UE of less than 1 UE per 100 ventilator days has been established in the literature, and many quality initiatives have been followed to reduce the number of UE.
Method: This study was approved by Princess Noura University Institutional Review Board in Riyadh Saudi Arabia as a quality improvement project. Data were extracted from a level 2, 18 bed, Neonatal Intensive Care Unit (NICU) in a hospital in Riyadh Saudi Arabia for all ventilated neonates regardless of gestational age. This QI project began in March 2020 using a Plan-Do-Study-Act (PDSA) Quality Improvement (QI) approach to identify the needed gaps and improvement areas to decrease UE in the NICU. As a result, a training program was initiated to train the NICU staff: Registered Nurses (RN) and Respiratory Therapists (RT) to work collaboratively on established evidence-based guidelines when care and procedures were provided to an intubated neonate in NICU. Examples of these procedures and care are endotracheal suctioning provided by RTs and RNs together, bedside chest X-Ray to be done in the presence of both RT and RN to assist in holding the endotracheal tube while the neonate is being handled, and the initiation of a multidisciplinary investigation process within 24-hour for any UE. Lastly, as part of the PDSA approach, an awareness campaign within the NICU was initiated by educating the staff on the negative implications of UE from a QI perspective in a daily multidisciplinary huddle meeting.
Results: In 2019, prior to the initiation of the QI project, the total UE in the unit was 1.7 per 100 ventilator days. Upon project initiation, a total of 50 NICU staff were trained as part of the project (RNs=29, RTs=21). All the staff passed the training program with satisfactory performance criteria by the NICU educator. Since the initiation of the project in March 2020, the total UE rate has decreased to 0.4 per 100 ventilator days.
Conclusion: The results of this continuing QI project showed the effectiveness of the established PDSA QI method by showing a decrease in the UE rate below the recommended UE rate of < 1.0 UE per 100 ventilator days in the literature.