Analyzing an Organization's Unplanned Extubation Data Set to Develop an Improvement Recommendation

Abstract

Purpose. The purpose of this quality improvement (QI) project was to analyze an organization’s unplanned extubation (UE) data set and to provide an evidence-based recommendation to assist in minimizing these adverse events (AE).Background. Critically ill patients often need an endotracheal tube (ETT) attached to a mechanical ventilator to support effective breathing and other homeostatic processes. A risk associated with mechanical ventilation is premature removal of the ETT, whether by the patient or accidentally. UE rates in the intensive care unit (ICU) are speculated to be between 2 and 8.7%, with other studies citing up to 22.5% (Ai et al., 2018; Smilow, 2013). Certain risk factors, such as ineffective sedation, improper use of restraints, and staffing concerns, can precipitate a UE (Chao et al., 2017; Cosentino et al., 2017). UE is a prominent issue in the critical care environment due to its effect on patient morbidity and mortality. Methods. This QI project analyzes UE events within Banner Health’s nonacademic ICUs in 2021. Banner Health’s nursing research department provided deidentified data in nursing event logs that discuss UE events. The project coordinator (PC) conducted a literature review to determine risk factors associated with UE and then analyzed Banner Health’s data set to deduce which variables are associated with UE. Results. After data analysis, the PC provided Banner Health’s nursing research department with a four-part evidence-based recommendation for improvement. This recommendation highlights factors involved in the organization’s UE events in 2021 and provides a revised reporting tool the organization may consider for recording future UEs. Conclusions. UE may be minimized by identifying organizational-level factors, such as improper sedation, restraint failure, and spontaneous breathing trials (SBT). Ongoing education for staff is also indicated to continue further minimization of UE.