Reducing Unplanned Extubations in the Intensive Care Unit With Evidence-Based Practice Recommendations

Abstract

Purpose: The purpose of the quality improvement (QI) project was to analyze a deidentified datasetof unplanned extubations (UEs) events throughout Banner Health's academic hospitals in 2021, complete a literature analysis, and provide evidence-based recommendations (EBR) to Banner Health. Background: Mechanical ventilation through endotracheal intubation is a common intervention in intensive care units (ICUs) to address acute respiratory distress. UEs lead to complications and increased healthcare costs. The incidence of UE is associated with risk factors, including patient- related factors and clinical practice gaps. Within the context of Banner Health’s academic medicine division, a needs assessment found addressing UEs is crucial. Methodology: An extensive literature search and analysis on UEs in adult ICUs was completed. Once Banner Health’s RDC was approved, data analysis was completed. Data was manually tallied on a dataset recording Excel document. A formal EBR was provided to the Banner Health system to improve UE incidence. Results: Self-extubations (SEs) significantly outweigh accidental extubations (AEs), accounting for 97% of the 70 reported events. BUMCP reported the highest number of UEs. Night shift accounted for the majority of UEs, approximately 54%, with a substantial portion occurring within two hours of shift transitions. Concerns regarding physical restraint use, sedation, and staffing were prevalent in the data. Most UEs did not require immediate reintubation; one event resulted in a patient fatality. Conclusions: The EBR to Banner Health is that current practices be evaluated -- including nurse staffing/characteristics, pain management, sedation/agitation management, and delirium management and education be delivered to nursing staff to address the risk factors. The ICU Liberation Bundle and PADIS guidelines guide these continuous quality improvement efforts.