Glenn Tara J, Grathwol Melissa M, McClary Jacquelyn D, Wainwright Rebecca J, Gorman Sara M, Rodriguez Ashley M, Bhola Monika
Department of Pediatrics, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH, USA.
Department of Pediatrics, Case Western Reserve University, Cleveland, OH, USA.
Pediatr Qual Saf. 2019 Nov 12;4(6):e234. doi: 10.1097/pq9.0000000000000234. eCollection 2019 Nov-Dec.
Endotracheal intubation carries the risk of discomfort, decompensation, oral trauma, and endotracheal tube malposition. Treatment with premedications reduces complications, increases overall intubation safety, improves pain control, and improves first-pass success. However, time is frequently a barrier to administration. We aimed to decrease the decision-to-intubation time interval from a baseline of 40 minutes to less than 35 minutes over 6 months.
We used the Model for Improvement with multiple plan-do-study-act cycles to reduce the time from decision to successful intubation in nonemergent neonatal intubations. Key drivers were timely administration of medications, availability of skilled personnel and equipment, and efficient use of time.
During this project, time from the decision to successful intubation decreased from a historical mean of 40 minutes to a new baseline of 27 minutes. This change represents a 33% decrease, with 80% of intubations occurring within 35 minutes. During this time, success rates remained stable, and medication errors and side effects did not increase.
Standard processes to prepare and administer premedications decreased the time from decision to intubation without significant adverse effects, allowing the benefit of premedication administration in a safe and timely manner in nonemergent neonatal intubations.
气管插管存在不适、失代偿、口腔创伤和气管导管位置不当的风险。使用术前用药进行治疗可减少并发症、提高整体插管安全性、改善疼痛控制并提高首次插管成功率。然而，时间常常是给药的障碍。我们的目标是在6个月内将决定插管至实际插管的时间间隔从基线的40分钟缩短至35分钟以内。
我们采用多轮计划-实施-研究-改进循环的改进模型，以缩短非紧急新生儿插管从决定到成功插管的时间。关键驱动因素包括及时给药、熟练人员和设备的可用性以及时间的有效利用。
在该项目期间，从决定到成功插管的时间从历史平均40分钟降至新基线27分钟。这一变化意味着减少了33%，80%的插管在35分钟内完成。在此期间，成功率保持稳定，用药错误和副作用并未增加。
准备和给予术前用药的标准流程缩短了决定插管至实际插管的时间，且无明显不良反应，使得在非紧急新生儿插管中能够安全、及时地获得术前用药的益处。
