Multidisciplinary interventions and continuous quality improvement to reduce unplanned extubation in adult intensive care units A 15-year experience

doi:10.1097/MD.0000000000006877

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Title:	Multidisciplinary interventions and continuous quality improvement to reduce unplanned extubation in adult intensive care units A 15-year experience
Authors:	Chao, Chien-Ming Lai, Chih-Cheng Chan, Khee-Siang Cheng, Kuo-Chen Ho, Chung-Han Chen, Chin-Ming Chou, Willy
Contributors:	Chi Mei Med Ctr, Dept Intens Care Med Chi Mei Med Ctr, Dept Intens Care Med Chi Mei Med Ctr, Dept Internal Med Chung Hwa Univ Med Technol, Dept Safety Hlth & Environm Chi Mei Med Ctr, Dept Med Res Chia Nan Univ Pharm & Sci, Dept Pharm Chia Nan Univ Pharm & Sci, Dept Recreat & Hlth Care Management
Keywords:	continuous quality improvement intensive care unit unplanned extubation
Date:	2017-07
Issue Date:	2018-11-30 15:54:10 (UTC+8)
Publisher:	Lippincott Williams & Wilkins
Abstract:	We conduct a retrospective study of patients with unplanned extubation (UE) in adult intensive care units (ICU) at a medical center. In 2001, a multidisciplinary team of intensivists, senior residents, nurses, and respiratory therapists was established atChi Mei Medical Center. The improvement interventions, implemented between 2001 and 2015, were organized around 8 key areas: standardizing procedures, improving communication skills, revising sedation and weaning protocols, changing strategies for restraints, establishing a task force for identifying and managing high-risk patients, using new quality-improvement models as breakthrough series and team resource management, using the strategy of accountability without assigning blame, and changing a new method to secure endotracheal tube. We measured the outcome as the annual event and the rate of UE. During this 15-year period, there were 1404 episodes of UE, with 44,015 episodes of mechanical ventilation (MV) (319,158 ventilator-days). The overall rate of UE was 3.19/100 ventilated patients (4.40/1000 ventilator-days). In 2001, there were 188 episodes of UE and the rate of UE was 6.82/100 ventilated patients or 9.0/1000 ventilator-days. After this continue quality improvement project had been implemented, the annual number of episodes of UE declined to 27, and the rate fell to 0.95/100 ventilated patients or 1.36/1000 ventilator-days in 2015. Overall, the trend analysis showed the change was significant with P < .0001. In conclusion, UE in adult ICU can be continuously and effectively reduced using multidisciplinary and sequential quality improvement interventions. Abbreviations: BTS = breakthrough series, ETT = endotracheal tube, ICU = intensive care unit, MV = mechanical ventilation, TRM = team resource management, UE = unplanned extubation.
Relation:	Medicine, v.96, n.27, e6877
Appears in Collections:	[Dept. of Recreation and Health-Care Management] Periodical Articles

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