Synergizing Safety: A Customized Approach to Curtailing Unplanned Extubations Through Shared Decision-Making in the NICU

Authors

Parvathy Krishnan, From the Department of Neonatal-Perinatal Medicine, Westchester Medical Center, and New York Medical College, Valhalla, N.Y.
Nilima Jawale, From the Department of Neonatal-Perinatal Medicine, Westchester Medical Center, and New York Medical College, Valhalla, N.Y.
Adam Sodikoff, From the Department of Neonatal-Perinatal Medicine, Westchester Medical Center, and New York Medical College, Valhalla, N.Y.
Susan R. Malfa, From the Department of Neonatal-Perinatal Medicine, Westchester Medical Center, and New York Medical College, Valhalla, N.Y.
Kathleen McCarthy, From the Department of Neonatal-Perinatal Medicine, Westchester Medical Center, and New York Medical College, Valhalla, N.Y.
Lisa M. Strickrodt, From the Department of Neonatal-Perinatal Medicine, Westchester Medical Center, and New York Medical College, Valhalla, N.Y.
Diana D'Agrosa, From the Department of Neonatal-Perinatal Medicine, Westchester Medical Center, and New York Medical College, Valhalla, N.Y.
Alexandra Pickard, From the Department of Neonatal-Perinatal Medicine, Westchester Medical Center, and New York Medical College, Valhalla, N.Y.
Lance A. Parton, From the Department of Neonatal-Perinatal Medicine, Westchester Medical Center, and New York Medical College, Valhalla, N.Y.
Meenakshi Singh, From the Department of Neonatal-Perinatal Medicine, Westchester Medical Center, and New York Medical College, Valhalla, N.Y.Follow

Author Type(s)

Resident/Fellow, Faculty

DOI

10.1097/pq9.0000000000000729

Journal Title

Pediatric Quality & Safety

First Page

e729

Document Type

Article

Publication Date

1-1-2024

Department

Pediatrics

Abstract

BACKGROUND: Unplanned Extubation (UE) remains an important patient safety issue in the Neonatal Intensive Care Unit. Our SMART AIM was to decrease the rate of UE by 10% from the baseline from January to December 2022 by emphasizing collaboration among healthcare professionals and through the use of shared decision-making. METHODS: We established an interdisciplinary Quality Improvement team composed of nurses, respiratory therapists, and physicians (MDs). The definition of UE was standardized. UE was audited using an apparent cause analysis form to discern associated causes and pinpoint areas for improvement. Interventions were implemented in a step-by-step fashion and reviewed monthly using the model for improvement. A shared decision-making approach fostered collaborative problem-solving. RESULTS: Our baseline UE rate was 2.3 per 100 ventilator days. Retaping, general bedside care, and position change accounted for over 50% of the UE events in 2022. The rate of UE was reduced by 48% by the end of December 2022. We achieved special-cause variation by the end of March 2023. CONCLUSIONS: The sole education of medical and nursing providers about various approaches to decreasing unnecessary retaping was ineffective in reducing UE rates. Shared decision-making incorporating inputs from nurses, respiratory therapists, and MDs led to a substantial reduction in the UE rate and underscores the potential of systematic evaluation of risk factors combined with collaborative best practices.

Recommended Citation

Krishnan, P., Jawale, N., Sodikoff, A., Malfa, S. R., McCarthy, K., Strickrodt, L. M., D'Agrosa, D., Pickard, A., Parton, L. A., & Singh, M. (2024). Synergizing Safety: A Customized Approach to Curtailing Unplanned Extubations Through Shared Decision-Making in the NICU. Pediatric Quality & Safety, 9 (3), e729. https://doi.org/10.1097/pq9.0000000000000729