Literature DB >> 26796128

Prevention of unplanned extubations in neonates through process standardization.

T D Fontánez-Nieves1, M Frost1, E Anday1, D Davis1, D Cooperberg2, A J Carey1.   

Abstract

OBJECTIVE: Unplanned extubation events (UPEs) in neonates are hazardous to patient safety. Our goal was to reduce UPE rate (#UPEs per 100 ventilator days) by 50% in 12 months at our 25-bed level III inborn unit. STUDY
DESIGN: Baseline data were gathered prospectively for 7 months. Three Plan-Do-Study-Act (PDSA) cycles targeting main causes of UPEs were developed over the next 20 months. Causes of UPEs were analyzed using Pareto charts; and a U control chart was created with QI Charts(©). Standard rules for detecting special cause variation were applied. RESULT: Mean UPE rate decreased from 16.1 to 4.5 per 100 ventilator days, a 72% decrease, exceeding our goal. Analysis of U-chart demonstrated special cause variation, with eight consecutive points below the mean. Improvement was sustained throughout the study period.
CONCLUSION: UPEs in neonates can be reduced with process standardization and frontline staff education, emphasizing vigilant endotracheal tube (ETT) maintenance.

Entities:  

Mesh：

Year:  2016        PMID： 26796128     DOI： 10.1038/jp.2015.219

Source DB:  PubMed          Journal:  J Perinatol        ISSN： 0743-8346            Impact factor:   2.521


  11 in total

1.  Incidence and risk factors of accidental extubation in a neonatal intensive care unit.

Authors:  Fabiana L Carvalho; Maria Aparecida Mezzacappa; Roseli Calil; Helymar da Costa Machado
Journal:  J Pediatr (Rio J)       Date:  2010-04-16       Impact factor: 2.197

2.  Unplanned extubation in NICU patients: are we speaking the same language?

Authors:  J M Meyers; J Pinheiro; M U Nelson
Journal:  J Perinatol       Date:  2015-09       Impact factor: 2.521

Review 3.  Unplanned extubation in the neonatal ICU: a systematic review, critical appraisal, and evidence-based recommendations.

Authors:  Paulo Sérgio Lucas da Silva; Maria Eunice Reis; Vânia Euzébio Aguiar; Marcelo Cunio Machado Fonseca
Journal:  Respir Care       Date:  2012-12-27       Impact factor: 2.258

Review 4.  Unplanned extubation in the NICU.

Authors:  Jessica A Barber
Journal:  J Obstet Gynecol Neonatal Nurs       Date:  2013-02-01

5.  Adverse events in the neonatal intensive care unit: development, testing, and findings of an NICU-focused trigger tool to identify harm in North American NICUs.

Authors:  Paul J Sharek; Jeffrey D Horbar; Wilbert Mason; Hema Bisarya; Cary W Thurm; Gautham Suresh; James E Gray; William H Edwards; Donald Goldmann; David Classen
Journal:  Pediatrics       Date:  2006-10       Impact factor: 7.124

6.  Characteristics and outcome of unplanned extubation in ventilated preterm and term newborns on a neonatal intensive care unit.

Authors:  Alex Veldman; Tina Trautschold; Katja Weiss; Doris Fischer; Karl Bauer
Journal:  Paediatr Anaesth       Date:  2006-09       Impact factor: 2.556

7.  Reducing unplanned extubations in the NICU.

Authors:  Lori Merkel; Kimberly Beers; Mary M Lewis; Joy Stauffer; Dennis J Mujsce; Mitchell J Kresch
Journal:  Pediatrics       Date:  2014-05       Impact factor: 7.124

Review 8.  Best practice in stabilisation of oral endotracheal tubes: a systematic review.

Authors:  Anne Gardner; Dot Hughes; Robert Cook; Rachael Henson; Sonya Osborne; Glenn Gardner
Journal:  Aust Crit Care       Date:  2005-11       Impact factor: 2.737

Review 9.  Unplanned extubation in pediatric critically ill patients: a systematic review and best practice recommendations.

Authors:  Paulo Sérgio Lucas da Silva; Werther Brunow de Carvalho
Journal:  Pediatr Crit Care Med       Date:  2010-03       Impact factor: 3.624

Review 10.  Methods for securing endotracheal tubes in newborn infants.

Authors:  Melissa Lai; Garry D T Inglis; Karen Hose; Luke A Jardine; Mark W Davies
Journal:  Cochrane Database Syst Rev       Date:  2014-07-31
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  9 in total

1.  Enhanced recovery after surgery (ERAS) protocols in neonates should focus on the respiratory tract.

Authors:  Yuji Wakimoto; Sathyaprasad Burjonrappa
Journal:  Pediatr Surg Int       Date:  2019-02-02       Impact factor: 1.827

2.  Counting unplanned extubations: marked variation among neonatologists.

Authors:  S Mbi Ndakor; M U Nelson; J M B Pinheiro
Journal:  J Perinatol       Date:  2017-02-02       Impact factor: 2.521

3.  Effect of Anatomical and Developmental Factors on the Risk of Unplanned Extubation in Critically Ill Newborns.

Authors:  L Dupree Hatch; Peter H Grubb; Melinda H Markham; Theresa A Scott; William F Walsh; James C Slaughter; Ann R Stark; E Wesley Ely
Journal:  Am J Perinatol       Date:  2017-05-11       Impact factor: 1.862

4.  Assessment of an Unplanned Extubation Bundle to Reduce Unplanned Extubations in Critically Ill Neonates, Infants, and Children.

Authors:  Darren Klugman; Kristin Melton; Patrick O'Neal Maynord; Aaron Dawson; Gowri Madhavan; Vicki Lee Montgomery; Mary Nock; Anthony Lee; Anne Lyren
Journal:  JAMA Pediatr       Date:  2020-06-01       Impact factor: 16.193

5.  Outcomes, Resource Use, and Financial Costs of Unplanned Extubations in Preterm Infants.

Authors:  L Dupree Hatch; Theresa A Scott; James C Slaughter; Meng Xu; Andrew H Smith; Ann R Stark; Stephen W Patrick; E Wesley Ely
Journal:  Pediatrics       Date:  2020-05-06       Impact factor: 7.124

6.  Reducing Time to First Dose of Antibiotic: The Example of Asymptomatic Neonates Exposed to Chorioamnionitis.

Authors:  Samuel Ajayi; Folasade Kehinde; David Cooperberg; Suzanne M Touch
Journal:  Pediatr Qual Saf       Date:  2021-05-05

7.  Multidisciplinary interventions and continuous quality improvement to reduce unplanned extubation in adult intensive care units: A 15-year experience.

Authors:  Chien-Ming Chao; Chih-Cheng Lai; Khee-Siang Chan; Kuo-Chen Cheng; Chung-Han Ho; Chin-Ming Chen; Willy Chou
Journal:  Medicine (Baltimore)       Date:  2017-07       Impact factor: 1.889

8.  Reducing Unplanned Extubations Across a Children's Hospital Using Quality Improvement Methods.

Authors:  Sarah B Kandil; Beth L Emerson; Michael Hooper; Rebecca Ciaburri; Christie J Bruno; Nancy Cummins; Virginia DeFilippo; Beth Blazevich; Adrienne Loth; Matthew Grossman
Journal:  Pediatr Qual Saf       Date:  2018-12-11

9.  Experiences of a Regional Quality Improvement Collaborative to Reduce Unplanned Extubations in the Neonatal Intensive Care Unit.

Authors:  Melissa U Nelson; Joaquim M B Pinheiro; Bushra Afzal; Jeffrey M Meyers
Journal:  Children (Basel)       Date:  2022-08-07
  9 in total

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