A Quality Improvement Project to Reduce Unplanned Extubations in the Neonatal Intensive Care Unit.

IF 1.6 4区医学 Q2 NURSING

Advances in Neonatal Care Pub Date : 2024-08-22 DOI:10.1097/ANC.0000000000001191

Adelaide B Caprio, Krystle N Niewinski, Sara Murphy, Anne Geistkemper, Laura M Seske

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引用次数: 0

Abstract

Background: Unplanned extubations (UEs) continue to be one of the most common adverse events in the neonatal intensive care unit (NICU). Management of endotracheal tubes (ETTs) can be particularly challenging in neonates due to the unique needs and physical characteristics of this patient population.

Purpose: The purpose of this quality improvement project was to decrease the rate of UEs from 0.76 to less than 0.5 per 100 ventilator days in an urban level III NICU in the Midwest, United States.

Methods: A newly formed interprofessional team created an evidence-based, standardized, bedside nurse-led care bundle for intubations and ETT care in the NICU. This project also created standardized, clear, closed-loop communication for the transition of bedside staff at shift change.

Results: The UE rate decreased from 0.76 to 0 per 100 ventilator days, reaching the goal of less than 0.5 per 100 ventilator days, during the 10-week project implementation period from December 2021 to February 2022.

Implications for practice and research: Many NICUs focus on reducing UEs due to the impact on healthcare resource utilization, acute complications, and long-term outcomes for infants. The development of a standardized, nurse-led care bundle for ETTs decreased the rate of UEs. Future research is needed to study the potential for generalization to different units and beyond the scope of the neonatal population.

查看原文本刊更多论文

减少新生儿重症监护室意外拔管的质量改进项目。

背景：意外拔管（UE）仍然是新生儿重症监护室（NICU）最常见的不良事件之一。目的：本质量改进项目旨在将美国中西部城市三级新生儿重症监护病房每 100 个呼吸机日的意外拔管率从 0.76 降至 0.5 以下：方法：一个新成立的跨专业团队为新生儿重症监护室的插管和 ETT 护理创建了一个以证据为基础、标准化、由床旁护士主导的护理包。该项目还为床旁工作人员的交接班建立了标准化、清晰的闭环沟通：结果：在 2021 年 12 月至 2022 年 2 月为期 10 周的项目实施期间，每 100 个呼吸机日的 UE 率从 0.76 降至 0，达到了每 100 个呼吸机日低于 0.5 的目标：许多新生儿重症监护室都将重点放在了减少 UEs 上，因为 UEs 会影响医疗资源的使用、急性并发症和婴儿的长期预后。由护士主导的标准化 ETT 护理包的开发降低了 UE 的发生率。未来需要进行研究，以探讨将其推广到不同单位和新生儿群体以外的可能性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Advances in Neonatal Care NURSING-

CiteScore

2.60

自引率

5.90%

发文量

101

期刊介绍： Advances in Neonatal Care takes a unique and dynamic approach to the original research and clinical practice articles it publishes. Addressing the practice challenges faced every day—caring for the 40,000-plus low-birth-weight infants in Level II and Level III NICUs each year—the journal promotes evidence-based care and improved outcomes for the tiniest patients and their families. Peer-reviewed editorial includes unique and detailed visual and teaching aids, such as Family Teaching Toolbox, Research to Practice, Cultivating Clinical Expertise, and Online Features. Each issue offers Continuing Education (CE) articles in both print and online formats.