Reintubation in the Post Anesthesia Care Unit: Lessons Learned

Abstract

Purpose: The purpose of this Doctor of Nursing Practice (DNP) project was to present anesthesia providers about the reintubation rates in the post-anesthesia care unit (PACU) at a facility in southern Texas. Included in this presentation, based on current literature, were risk factors that contribute to reintubation and ways to assess appropriate measures for extubating patients under general anesthesia. Background: Reintubation in the PACU is a traumatizing experience for patients, families, and PACU nurses. This event can ultimately result in morbidity and mortality if not recognized early (Liu et al., 2021). These events lead to increased costs for both the hospital and the patient. By identifying the root cause of why reintubation occurs, it is imperative to reinforce this information to anesthesia providers resulting in improved anesthesia management. Methods: Lippitt’s Theory of Change, which is based on bringing in an external change agent to put a plan in place to make changes, guided this DNP project. An educational presentation followed by a post-pre survey (20 questions) was designed to assess anesthesia providers knowledge of patients at risk of reintubation, and to evaluate their current practice. A 60-day post-presentation survey assessed if they have made any changes to their practice. Results: There were 18 participants who filled out the survey after the educational presentation. The areas of improvement from pre to post included: identification of risk factors for age and gender, increased knowledge about incidence of postoperative residual paralysis, how to perform a negative inspiratory force test and how to test for a cuff leak. A 60-day survey was distributed to assess any changes in practice after the presentation. There were 11 participants who submitted their survey in which 6 (54.5%) providers have changed their practice to include neuromuscular blockade assessment with a nerve stimulator. The remaining 5 (45.5%) participants have not changed their practice. Conclusions: It was noted that there was a 0.8% (3/367) reintubation rate in a 3-month period at the project site, which is low compared to national rates. This educational presentation improved knowledge regarding reintubation risks and possible causes. The 60-day survey resulted in a positive change in practice with assessing and documenting neuromuscular blockade.