Teneisha Hunt, MSN, CPNP
Pediatric Nurse Practitioner
Nemours Childrens Hospital
Orlando, Florida
Disclosure information not submitted.
Title: Effective Use of Quality Improvement Strategies to Minimize Chest Tube Dislodgment in Pediatric ICU
Introduction: Thoracostomy tubes are utilized within the pediatric population to manage pneumothoraces and hydrothoraces in critically ill patients. While important in the management of various pediatric pulmonary and extrapulmonary pathologies, maintaining chest tubes in the pediatric population can be challenging. Inadvertent dislodgment can lead to the need for additional procedures and sedation. We aimed to reduce the rate of inadvertent chest tube dislodgments through the creation and implementation of a standardized chest tube maintenance bundle and nursing education.
Methods: This was designed as a quality improvement project. We created a multidisciplinary team and completed Plan-Do-Study-Act cycles to achieve the project aim. This is a single center study completed at a tertiary care children’s hospital.
PATIENTS: Patients were included in this intervention if they required chest tube placement and maintenance of chest tube or those patients requiring placement of chest tube during admission to Nemours Children’s Hospital.
INTERVENTIONS: Creation of a multidisciplinary team, implementation of a standardized maintenance bundle, education on this bundle, placing laminated hard copies of the maintenance bundle at bedside for each child with a chest tube, adding documentation that follows the bundle to the electronic health record, transition of the standard chest tube dressing. The primary outcome measure was the rate of dislodged chest tubes and secondary was the total number of chest tube days required.
Results: A total of 56 patients were analyzed, including 28 from the baseline period (January 2018-December 2018) and 28 from the post intervention period (January 2019-December 2019). During the baseline period the dislodgement rate was 18%. During the post intervention period (January 2019-December 2019) there was a dislodgement rate of 2%. The average number of chest tube days in the pre-intervention period was 6 days and the average number in the post intervention period was 5.2 days.
Conclusions: A standardized maintenance bundle decreased the rate of inadvertent chest tube dislodgments by 16% and there was a decrease in the average number of chest tube days.