Kandil Sarah B, Emerson Beth L, Hooper Michael, Ciaburri Rebecca, Bruno Christie J, Cummins Nancy, DeFilippo Virginia, Blazevich Beth, Loth Adrienne, Grossman Matthew
Department of Pediatrics, Yale School of Medicine, New Haven, Conn.
Pediatr Qual Saf. 2018 Dec 11;3(6):e114. doi: 10.1097/pq9.0000000000000114. eCollection 2018 Nov-Dec.
Children who require an endotracheal (ET) tube for care during critical illness are at risk of unplanned extubations (UE), or the unintended dislodgement or removal of an ET tube that can lead to significant patient harm. A proposed national benchmark is 1 UE per 100 ventilator days. We aimed to reduce the rate of UEs in our intensive care units (ICUs) from 1.20 per 100 ventilator days to below the national benchmark within 2 years.
We identified several key drivers including ET securement standardization, safety culture, and strategies for high-risk situations. We employed quality improvement methodologies including apparent cause analysis and plan-do-study-act cycles to improve our processes and outcomes.
Over 2 years, we reduced the rate of UEs hospital-wide by 75% from 1.2 to 0.3 per 100 ventilator days. We eliminated UEs in the pediatric ICU during the study period, while the UE rate in the neonatal ICU also decreased from 1.2 to 0.3 per 100 ventilator days.
We demonstrated that by using quality improvement methodology, we successfully reduced our rate of UE by 75% to a level well below the proposed national benchmark.
在危重病期间需要气管内（ET）插管进行护理的儿童存在意外拔管（UE）的风险，即ET管意外移位或拔除，这可能会对患者造成严重伤害。提议的全国基准是每100个呼吸机日发生1次UE。我们的目标是在2年内将重症监护病房（ICU）的UE发生率从每100个呼吸机日1.20次降至全国基准以下。
我们确定了几个关键驱动因素，包括ET固定标准化、安全文化以及针对高风险情况的策略。我们采用了质量改进方法，包括明显原因分析和计划-执行-研究-行动循环，以改进我们的流程和结果。
在2年多的时间里，我们将全院的UE发生率从每100个呼吸机日1.2次降低了75%，降至0.3次。在研究期间，我们消除了儿科ICU的UE，而新生儿ICU的UE发生率也从每100个呼吸机日1.2次降至0.3次。
我们证明，通过使用质量改进方法，我们成功地将UE发生率降低了75%，降至远低于提议的全国基准的水平。
