Abstract
Objective
To evaluate the effectiveness of a continuous quality improvement (CQI) program in reducing the incidence of unplanned endotracheal extubation.
Design
Prospective study over a 9-month period.
Setting
Adult intensive care units (ICUs including coronary care unit, medical ICU, surgical ICU, and cardiovascular surgical ICU) in a university-affiliated medical center.
Patients
831 consecutive mechanically ventilated patients.
Interventions
CQI program focusing on standardization of procedures, improvement of communication, and identification and management of high-risk patients.
Measurements and results
With the implementation of this CQI program, the overall incidence density of unplanned extubation (defined as number of new unplanned extubations per mechanical ventilation patient-days) significantly decreased from 2.6% in the first trimester to 1.5% in the second trimester and 1.2% in the third trimester (p=0.01). This reduction was essentially the result of a decrease in unplanned extubation in orally intubated patients (incidence density 4.6, 1.7 and 1.0% for three trimesters, respectively;p<0.0001). Unplanned extubation in nasally intubated patients remained largely unaffected (1.2, 1.4, and 1.4% for three trimesters, respectively;p=0.92).
Conclusions
The implementation of a concerted CQI program is effective in reducing the overall incidence of unplanned endotracheal extubation.
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References
Coppolo DP, May JJ (1990) Self-extubations: a 12-month experience. Chest 98:165–169
Tindol GA, DiBenedetto RJ, Kosciuk L (1994) Unplanned extubations. Chest 105:1804–1807
Vassal T, Anh NGD, Gabillet JM, Guidet B, Staikowsky F, Offenstadt G (1993) Prospective evaluation of self-extubations in a medical intensive care unit. Intensive Care Med 19:340–342
Whelan J, Simpson SQ, Levy H (1994) Unplanned extubation: predictors of successful termination of mechanical ventilatory support. Chest 105:1808–1812
Listello D, Sessler CN (1994) Unplanned extubation: clinical predictors for reintubation. Chest 105:1496–1503
Joint Commission on Accreditation of Healthcare Organizations (1988) Step by step through the monitoring and evaluation process. In: Examples of monitoring and evaluation in respiratory care services. JCAHO, Oakbrook Terrace, IL, pp 17–36
Levy H, Griego L (1993) A comparative study of oral endotracheal tube securing methods. Chest 104:1537–1540
Nightingale SL (1992) Waring about use of protective restraint devices. JAMA 267:1442
Kaplow R, Bookbinder M (1994) A comparison of four endotracheal tube holders. Heart Lung 23:59–66
Tasota FJ, Hoffman LA, Zullo TG, Jamison G (1987) Evaluation of two methods used to stabilize oral endotracheal tubes. Heart Lung 16:140–146
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Mailing address: Maria Parham Hospital, 1801 Ruin Creek Rd, Suite 002, Henderson, NC 27536, USA FAX: +1(919) 431-2088
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Chiang, A.A., Lee, K.C., Lee, J.C. et al. Effectiveness of a continuous quality improvement program aiming to reduce unplanned extubation: A prospective study. Intensive Care Med 22, 1269–1271 (1996). https://doi.org/10.1007/BF01709348
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DOI: https://doi.org/10.1007/BF01709348