Quality improvement activities in an NICU: Stop UNplanned eXtubation (SUNX).

IF 1 4区医学 Q3 PEDIATRICS

Pediatrics International Pub Date : 2025-01-01 DOI:10.1111/ped.15889

Hidehiko Maruyama, Shoichiro Amari, Kana Yamada, Ayumi Ohshima, Kanako Sugashima, Naomi Homma, Tetsuya Isayama, Yushi Ito

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引用次数: 0

Abstract

Background: A target unplanned extubation (UE) rate of <1/100 ventilator days has been recommended. Our hospital has 21 NICU beds (12 beds in NICU 2 and 3 for extremely low birth weight [ELBW] infants). In 2020, we experienced an abrupt UE increase, leading to the initiation of the Stop UNplanned eXtubation (SUNX) project. At that time, UE rate was 1.30/100 ventilator days. The aim of the SUNX project was to keep the low UE rate.

Methods: We collected data on UE rates from April 2019 to March 2024. The intervention was implemented through Plan-Do-Study-Act cycles. Cause analysis with the Pareto chart led to the drivers, we had to deal with: judicious use of sedations, Endotracheal tube (ETT) tape loosening, and stuff number during infant care. Additionally, we did simulation training for sudden SpO₂ decrease and UE event review. We also gathered data about ELBW infant admission and their NICU stay.

Results: The UE rate in total NICU was kept lower than 1/100 ventilator days after the intervention. After our intervention, we found no special cause variation. It meant that our intervention was not statistically significant. However, our intervention gradually penetrated into the NICU daily practices; judicious use of sedation, ETT tape template, body position change by two nurses, UE event review, and so on. We continued a systematic approach to preventing UE.

Conclusions: Although abrupt UE increase in 2020 might be a special cause variation, SUNX activities brought us systematic approach for UE prevention.

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NICU质量改进活动：停止非计划拔管（SUNX）。

方法：我们收集了2019年4月至2024年3月的UE率数据。该干预措施通过计划-执行-研究-行动循环实施。根据帕累托图的原因分析，我们必须处理的原因是：镇静剂的合理使用，气管插管（ETT）胶带松动，以及婴儿护理期间的物品数量。此外，我们还进行了SpO2突然降低和UE事件回顾的模拟训练。我们还收集了ELBW婴儿入院和新生儿重症监护病房住院的数据。结果：干预后NICU总UE率保持在1/100呼吸机d以下。经过我们的干预，我们没有发现特殊原因的变异。这意味着我们的干预没有统计学意义。然而，我们的干预逐渐渗透到新生儿重症监护病房的日常实践中；明智地使用镇静剂、ETT胶带模板、两名护士体位改变、UE事件回顾等。我们继续采取系统方法预防UE。结论：尽管2020年UE的突然增加可能是特殊的原因变化，但SUNX活动为UE的预防提供了系统的方法。

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

Pediatrics International 医学-小儿科

CiteScore

2.00

自引率

7.10%

发文量

519

审稿时长

12 months

期刊介绍： Publishing articles of scientific excellence in pediatrics and child health delivery, Pediatrics International aims to encourage those involved in the research, practice and delivery of child health to share their experiences, ideas and achievements. Formerly Acta Paediatrica Japonica, the change in name in 1999 to Pediatrics International, reflects the Journal''s international status both in readership and contributions (approximately 45% of articles published are from non-Japanese authors). The Editors continue their strong commitment to the sharing of scientific information for the benefit of children everywhere. Pediatrics International opens the door to all authors throughout the world. Manuscripts are judged by two experts solely upon the basis of their contribution of original data, original ideas and their presentation.