726 - Reducing Unplanned Extubations in the Neonatal Intensive Care Unit

Poster Number: 726
Publication Number: 726.342

Krystle Niewinski, Rush University Medical Center, Wheaton, IL, United States; Adelaide B. Caprio, Rush University Medical Center, Chicago, IL, United States; Sara Murphy, Rush University Medical Center, Chicago, IL, United States; Anne Geistkemper, Rush University Medical Center, Lombard, IL, United States; Laura M. Seske, Rush University Medical Center, Chicago, IL, United States

Background: Unplanned extubation (UE) is defined as an event in which there is an unexpected dislodgement of the endotracheal tube at a time that was not intended or ordered. UE is the fourth most common adverse event in the NICU. In the NICU, UEs are often accompanied by acute decompensation in clinical status and need for significant and/or prolonged cardiopulmonary resuscitation and emergent reintubation.

Objective: To reduce the rate of UEs in an urban, level III NICU to less than 0.5 per 100 ventilator days during a 10-week implementation period by utilizing a standardized, evidence-based endotracheal tube care bundle.

Design/Methods: An interdisciplinary UE improvement team was formed to develop AIR SQUAD, a standardized, evidence-based endotracheal tube care bundle. Education on the practice change was disseminated via email to all staff and discussed at staff meetings prior to implementation. Data sheets requiring hourly documentation were used to measure staff compliance with the new practice bundle.

Results: During the 10-week implementation period, from December 13th, 2021 through February 27th, 2022, there was a total of 335 ventilator days and zero unplanned extubations in the NICU.

Conclusion(s): A standardized, interdisciplinary approach to ETT securement and assessment can reduce and potentially eliminate unplanned extubations in the NICU. More research is needed to study sustainability of this intervention.