Reduction of Unplanned Extubations in the Neonatal Intensive Care Unit

Abstract

**Please note that the full text is embargoed** ABSTRACT: Unplanned extubations (UE) are a preventable adverse event which occurs when intubated patients have their endotracheal tubes (ETT) accidentally dislodged from their airway. The method of securing the ETT has been identified as the most common reason for unplanned extubations (Veldman et al. , 2006). The purpose of this project was to decrease the rate of UEs in the neonatal intensive care unit from 4.9 UEs per 100 ventilator days to less than two UEs per 100 ventilator days by implementing a standard method of securing the endotracheal tube with a securement device. Methods This was a prospective, controlled research design to compare outcomes for two groups. Data was collected in two phases; pre and post intervention. The population of interest was all staff within the Newborn Center. Data was collected on all intubated patients in the Newborn Center, Pavilion for Women NICU and West Tower NICU; over eight months looked to examine the rate of unplanned extubations. Data collected included gestational age, day of life at time of unplanned extubation, and weight at time of unplanned extubation. The intervention consisted of education followed by return demonstration on all staff within the Newborn Center and a standard method of securing the ETT with NeoBar™ as a securement device was implemented. Results A total of 418 patients were intubated during the project's timeframe with 5,271 ventilator days. Control group had 81 unplanned extubations for a rate of 3.2 UEs per 100 ventilator days and experimental group had 88 unplanned extubations for a rate of 3.3 UEs per 100 ventilator days. There was no statistical difference in the rate of UEs, gestational age, and weight between groups. While there was no statistical difference for the Newborn Center or for the West Tower NICU there were supportive changes in the Pavilion for NICU. There was a 34% decrease in the rate of unplanned extubations in the intubated neonates within the Pavilion for Women NICU. A statistical difference in the day of life at extubation with an increase in the age at time of UE from 12 days to 21 days (p = 0.03) in neonates with gestational age between 24-25 weeks control and experimental groups in the Pavilion for Women NICU only. Conclusions 5 The results of this study indicate a clinically significant decrease in the rate of UEs after nurses were trained to use the securement device and it became the standard of care during the final phase of this study. In the smaller gestational neonates there was a trend downwards in the overall rate of UEs along with a statistically significant (p=0.03) increase in the day of life for an initial UEs. NeoBar™ does appear to decrease the rate of UEs in the smaller gestational neonates. In the larger neonates, another option needs to be available for the neonates who are in between available sizes for the NeoBar™.