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WHERE IS MY ETT?: USING QUALITY IMPROVEMENT TO DECREASE UNPLANNED EXTUBATIONS IN A LARGE NICU SETTING
  1. Lindsy Broome,
  2. Isa Baruah,
  3. Suzane Iniguez,
  4. Rebecca Schiff
  1. Texas Children's Hospital, United States

Abstract

Background Texas Children's Hospital (TCH) has a 172 bed NICU. TCH NICU employs more than 450 RNs, 50 RTs, 98 NNPs, and over 150 physicians. As a consult center for complex critically ill neonates, many patients have respiratory management via an endotracheal tube (ETT). Proper ETT position is crucial to maintain patients' respiratory and cardiac function. Research shows approximately 20% of children and neonates who experience a UE have cardiovascular collapse requiring CPR or epinephrine. Baseline data showed a mean rate of 3.3 Unplanned Extubations (UE) per 100 ventilator days.

Objectives Reduce the Newborn Center UE rate from 3.3/100 vent days in FY 2014 to 2.64/100 vent days by September 30, 2016.

Methods A multidisciplinary team formed and responded to the problem. Debriefs were initiated by bedside clinicians after every UE to better understand the contributing factors. Using the operational definition from Solutions for Patient Safety, the team reviewed and themed every UE. Identified themes were: Agitation, ETT Depth, Unable to determine, Securement Device, Transfer/holding, and Bundle Compliance.

Results 33% reduction in UE in a rolling calendar year.

Conclusions Our outcomes identified that the NRP formula can be used as an assessment tool to determine need for an X-ray to check ETT placement and quickly identify ETTs that need adjustment. This has implications for clinical practice to help guide judicious radiation exposure. Ongoing work will be sustainment and growth with the literature (i.e. New NRP formula). With the rich data gained from each UE there are further opportunities for targeted improvement based on theme.

Figure 1

Unplanned extubation rate.

Figure 2

Themes for each unplanned extubation.

Figure 4

Poster for position of ETT.

  • Accreditation
  • Anaesthesia
  • Attitudes

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