CQI Programme on Prevention of Unplanned Extubation in Paediatrics Intensive Care Unit

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Authors (including presenting author) :
Cheng SM (1), Wong KY (1), Tang WY (1), Poon WNF (1), Lee SY (1)
Affiliation :
(1) Department of Paediatrics, Prince of Wales Hospital
Introduction :
In 2016, there were several incidents of unplanned extubation (UE) in our Paediatric Intensive Care Unit (PICU). These adverse incidents should be avoided as the consequences could be serious and might lengthen the ventilation days and hospital stay. Moreover, the incidents reflected the room for improvement in nursing care. Therefore, a quality improvement programme was designed to enhance the care and thus reducing the UE incidents.
Objectives :
1.To review on the gap in practice to prevent UE 2.To develop the appropriate care strategies to prevent UE 3.To reduce the incidents of UE
Methodology :
After conducting a literature review on the topic to find out the appropriate care to prevent UE and a retrospective case review of all intubated patients in 2016, we recognized the gap in our care. The bundle of care, involving eight components, to prevent UE was developed. The possibility of carrying out the bundle of care was discussed in meetings with doctors and nurses. Briefing sessions for nurses were held to share the proposed strategies including the bundle of care including the Risk Assessment Score, the consensus in the sedation level, the documentation of weaning plan, the secure of the endotracheal tube, the position of the endotracheal tube, the alert system if the State Behavioural Scale ≥ 1, the presence of designated accompany for pending extubation. A form was developed to facilitate communication and proper record. The main outcome of this CQI programme was undoubtedly the reduction in incidence of UE. In addition, a compliance audit was also conducted by random sampling after the roll out of the programme.
Result & Outcome :
In 2016, the total number of UE incidents reported was 5 and the UE rate is 2.31 per 100 ventilator days. After the CQI programme, the UE rate dropped to 1.3 per 100 ventilator days (3 UE incidents) in 2018. The contributing factors for the two incidents of UE were related to the non-compliance, in particular, loosening of strapping of the endotracheal tube and inappropriate time period for weaning sedation. Random sampling audits were performed monthly for four consecutive months in 2018 and the compliance rate was 86.7-100% (mean 95.1 %) indicating there were still rooms for improvement

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