Enhancing Safety in Mechanical Ventilation: A Quality Improvement Initiative Targeting Unplanned Extubations in a Tunisian PICU.

Abstract

Background: Unplanned extubation (UE) in pediatric intensive care units (PICUs) is a critical adverse event that can lead to severe complications, including respiratory distress and hypoxia. This study aimed to reduce UE incidence among mechanically ventilated children by implementing targeted quality improvement interventions.

Methods: A quality improvement initiative was conducted in a 7-bed PICU at a university-affiliated hospital in Tunisia from January 2022 to December 2023. The study included three phases: baseline assessment, intervention implementation, and postintervention evaluation. Approaches for improvement included using a key driver diagram and Pareto analysis which led to interventions such as standardized endotracheal tube (ETT) fixation procedures, sedation management, and staff training. The outcome was monitored using statistical process control methods, particularly a U chart to track UE rates.

Results: Following the implementation of the quality improvement interventions, the UE rate decreased from 3.62 to 2.06 per 100 ventilation days, a 42.7% reduction (P = 0.015). Statistical process control analysis indicated a statistically significant shift, confirming the effectiveness of the interventions.

Conclusions: Targeted quality improvement interventions, including standardized protocols and staff training, significantly reduced the incidence of UEs in the PICU. These findings underscore the importance of continuous improvement efforts in enhancing patient safety in resource-limited settings.