Problem:
Neonatal Intensive Care Units have a higher rate of Unplanned Extubation (UE) when compared to pediatric intensive care units due to the short length of the patient’s trachea, longer intubation times, challenges using adhesive on immature skin, and lack of routine sedation and paralysis for mechanical ventilation.
Measurement:
The root cause analysis (RCA) process is performed on each UE event. A chart audit on each UE is conducted to collect data captured in Microsoft Excel. Lastly, we implemented Statistical Process Control charts to generate a rate for UE per 100 patients days.
Analysis:
During our monthly UE workgroup meetings, each UE undergoes an RCA process to identify improvement opportunities and prevention strategies. The data is collected from the charts audits to identify any trends or common causes. The use of SPC charts allows us to evaluate if improvement initiatives were effective over time
Implementation:
Discussed UE data across NICU department meetings and coordinated with anesthesia to have a consistent approach for securing the ETT in patients returning from the OR. The common obstacle was staff engagement. We expanded the workgroup to be more multidisciplinary to provide transparency of the work efforts and opportunities identified.
Results/Discussion
Since implementing these improvement strategies, NICU UE rate per 100 vent days decreased from 0.44 to 0.19, a 57% improvement. Conducting RCAs allowed us to identify improvement strategies. The SPC provided a vivid picture of improvement over time. We are identifying opportunities to pull bundle and chart audit information electronically.
