Unplanned extubation in adult critical care. Quality improvement and education payoff.

To purchase reprints, contact The InnoVision Group, 101 Columbia, Aliso Viejo, CA 92656. Phone, (800) 8092273 or (949) 362-2050 (ext 532); fax, (949) 362-2049; e-mail, [email protected]. administration and a physician champion. As information and data were evaluated, the committee determined that although sedation and restraint were intermittently contributing factors to unplanned extubation, the techniques used for securing endotracheal tubes were the one factor that was consistently a problem. Staff members were using several different techniques to secure patients’ endotracheal tubes. Some patients had tube holders from other facilities that were unfamiliar to the staff; other patients had different methods of taping and products used. Some patients had their tube secured around their head; others had tape adhered to their bare skin. Because of the identified inconsistencies, the committee developed a plan to educate the nursing and respiratory care staff. The education consisted of training in new securing techniques, heightening awareness of patients’ activity levels, and improving knowledge about patients’ readiness for extubation. In this article, Amy L. Richmond, RN, CCRN Dena L. Jarog, RN, MSN, CCNS Vicki M. Hanson, RRT Endotracheal intubation is done many times a day in hospitals for patients who have or may have a problem with their airway. Once a patient is intubated, maintenance of the endotracheal tube is essential. In critical care units, the task of maintaining tube patency and placement is the responsibility of nursing and respiratory care professionals. For as long as patients have been intubated, the potential for unplanned removal of the endotracheal tube has been a source of concern. This concern has led nurses and other medical professionals to search for ways to decrease the occurrence of unplanned extubation. Unplanned extubation is defined as any accidental or purposeful removal of the endotracheal tube by a patient. Because of a high rate of unplanned extubations—2.14% in the medical intensive care unit (MICU)/coronary care unit (CCU) and 2.32% in the surgical ICU (SICU)—at a tertiary care hospital in north central Wisconsin, a quality control committee was formed to address methods for decreasing the unplanned extubation rate and increasing awareness of the rate of unplanned extubations. The committee consisted of staff from respiratory therapy, clinical nursing, and nursing ClinicalArticle