Reducing unplanned extubations

A quality improvement project in one neonatal intensive care unit attempted to reduce unplanned extubations through the use of multiple practices implemented through serial plan-do-study-act cycles. The practices were: use of two or more staff for procedures at risk of extubation (such as retaping and securing endotracheal tubes, weighing, and moving the infant out of the bed); placement of cards at each bedside that contained important and relevant information about the endotracheal tube; use of a commercial product to secure the endotracheal tube; and the use of restraining mittens in selected infants. Over time, between 2009 and 2013 the rate of unplanned extubations decreased from 2.4 per 100 patient-intubated days to around 0.5 per 100 patient-intubated days.

Reducing unplanned extubations in the NICU. Merkel et al, 2014.