O2114: Decreasing Unplanned Extubation Rates in a Level IV NICU

Purpose/Objectives: Unplanned extubations in neonates are associated with unfavorable outcomes including increased length of stay in the hospital, increased risk of ventilator-associated pneumonia, and increased risk of airway trauma and intraventricular hemorrhage. Our focus is to improve quality of care and patient safety by reducing the incidents of unplanned extubations in the NICU.

Design/Methods: The work presented in this abstract is a continuation of the journey started in the Fall of 2019. At that time the benchmark for UE was < 1/100 ventilator days. Since then, the goal has been reduced to 0.42/100 ventilator days. The following interventions have been established: Two to turn for movement and repositioning; signage added to the doors of the patients with ETTs; simulation training including the securement taping method; securement devices changed every 5 days; H-Y taping method used for patients who meet certain criteria; and review of all UEs weekly if one has occurred. Most recently, efforts have been made to focus on kangaroo care and the prevention of UEs. The team has created educational flyers and a video on UE prevention for parents.

Results: The team continues to see a reduction in UEs. From the start of the journey a 78% reduction in the incidence of UE has been seen.
FY20 1.83/100 vent days; FY21 1.06/100 vent days; FY22 0.76/100 vent days; FY23 0.77/100 vent days; FYTD24 0.41/100 vent days; FYTD25 0.29/100 vent days.

Conclusion/Discussion: By lowering the UE rate, patient harm was potentially impacted as evidenced by decreased lengths of stay, decreased ventilator associated pneumonia, decreased airway trauma, and decreased incidence of intraventricular hemorrhage. Data and interventions shared in this presentation should be shared with other Level IV NICUs for harm reduction.