Development and implementation of learning events to decrease the incidence of unplanned extubation in a peadiatric critical care unit

Abstract

Introduction: Unplanned extubation is an important quality issue in clinical practice as it is a common occurrence worldwide in the paediatric intensive care units (PICUs). Unplanned extubation of the paediatric patient is a disturbing global phenomenon and it accounts for 3% to 14% incidents per 100 ventilation days in paediatric intensive care units (PICU) in hospitals worldwide. In a PICU where the researcher works as a paediatric critical care nurse the average incidence of unplanned extubation prior to this research was 37% per 100 ventilation days, which is alarmingly higher than the global phenomenon. Paediatric patients are at a particular high risk for unplanned extubation due to their short tracheal length, the use of uncuffed oral endotracheal tubes, and the patient s developmental immaturity which may limit cooperation with healthcare professionals. Unplanned extubation of a paediatric patient is an adverse, avoidable event and therefore studies are needed to establish recommendations to prevent unplanned extubation. Aim: The overall aim of this study was to collaboratively plan and implement learning events to decrease the incidence of unplanned extubation in a PICU. Method: During Phase 1, data were collected by means of a clinical audit tool, all mechanically ventilated patients files were audited to determine the incidence and factors contributing to unplanned extubation, in a 7 bedded PICU, from January 2014 to 28 February 2014. The incidences of unplanned extubation were 37% of all mechanically ventilated paediatric patients. During Phase 2 of the study learning events were collaboratively developed with healthcare professionals working in the PICU, to address the identified factors contributing to unplanned extubation. The learning events were implemented for a period of two months, where after during Phase 3 of the study a re-audit of the files of the mechanically ventilated paediatric patient were conducted. Results: Following the implementations of the learning events for a period of two months the incidence of unplanned extubation of the mechanically ventilated paediatric patients decreased from 37% to 15% in the PICU. Conclusion: The collaborative development and implementation of learning events to address unplanned extubation in the PICU, raised awareness amongst healthcare professionals relating the factors contributing to unplanned extubation, enhanced teamwork amongst healthcare providers and improved ownership of the collaborative developed learning events. This in turn decreased the complications associated with unplanned extubation and had a positive outcome on terms of quality care provided to mechanically ventilated paediatric patients.