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UNINTENDED EXTUBATION: IMPROVING CARE FOR THE PEDIATRIC TRAUMA - - PowerPoint PPT Presentation
UNINTENDED EXTUBATION: IMPROVING CARE FOR THE PEDIATRIC TRAUMA - - PowerPoint PPT Presentation
UNINTENDED EXTUBATION: IMPROVING CARE FOR THE PEDIATRIC TRAUMA POPULATION Jennifer Fritzeen, MSN, RN, PCNS Trauma & Burn Program Manager Childrens National Medical Center Unintended Extubations Loss or displacement of the endotracheal
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Unintended Extubations Loss or displacement of the endotracheal tube prior to decision to extubate by the primary care team
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Complications of Unintended Extubation Increase ventilator days Nosocomial infections Prolonged ICU stay
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Unintended Extubation Events (N=102)
5 1 1 2 3 1 1 1 1 3 21 14 6 6 12 3 5 10 15 20 25 Q3 2011 Q4 2011 Q 1 2012 Q2 2012 Q3 2012 Q4 2012 Chest compressions Code medications Re-intubation
Number of intervention
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Event Root Cause Analysis
Unintended extubation Demographics Level of sedation Patient activity ETT placement Positioning & Safety Staffing
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Event Root Cause Analysis
Unintended extubation Demographics Age, Diagnosis, # ventilator days Level of sedation Patient activity ETT placement Positioning & Safety Staffing
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Event Root Cause Analysis
Unintended extubation Demographics Level of sedation Prn medications vs drips Patient activity ETT placement Positioning & Safety Staffing
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Event Root Cause Analysis
Unintended extubation Demographics Level of sedation Patient activity Restraints, procedures, interventions ETT placement Positioning & Safety Staffing
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Event Root Cause Analysis
Unintended extubation Demographics Level of sedation Patient activity ETT placement Positioning & Safety Active repositioning, tape secure, restraint use Staffing
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Event Root Cause Analysis
Unintended extubation Demographics Level of sedation Patient activity ETT placement Oral vs nasal Placement on x-ray Positioning & Safety Staffing
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Event Root Cause Analysis
Unintended extubation Demographics Level of sedation Patient activity ETT placement Positioning & Safety Staffing 1:1, paired
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0.2 0.4 0.6 0.8 1 1.2 1.4
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 2008 2009 2010 2011 2012 2013 2014 2015
UE/100 vent days
Quarterly Unintended Extubation Rates
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0.2 0.4 0.6 0.8 1 1.2 1.4
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 2008 2009 2010 2011 2012 2013 2014 2015
UE/100 vent days
Airway Protection Team
Quarterly Unintended Extubation Rates
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0.2 0.4 0.6 0.8 1 1.2 1.4
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 2008 2009 2010 2011 2012 2013 2014 2015
UE/100 vent days Standardized Taping
Quarterly Unintended Extubation Rates
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0.2 0.4 0.6 0.8 1 1.2 1.4
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 2008 2009 2010 2011 2012 2013 2014 2015
UE/100 vent days
Airway compliance bundle with weekly audits
Quarterly Unintended Extubation Rates
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Airway Compliance Bundle
ETT position verification – CXR, visual cue Team presence at X-ray rounds Upper extremity restraints Standardized ETT tape Sedation phase
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Comparison of Annual Unintended Extubation Rates
0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 2011 2012 2013 2014
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Comparison of Annual Unintended Extubation Rates
0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 2011 2012 2013 2014 PICU Trauma/ Burn
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Unintended Extubations –Trauma Patients N=6 100% lacked therapeutic sedation regimen 50% risk for neurologic deficit 33% required re-intubation – inhalation injury
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Average age 51 months 88 months Median age 24 months 90 months Reintubation rate 45% 33% Rate of continuous sedation use 71% 0%
Population Differences
PICU Trauma/Burn
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