Nurse-led initiative reduces unplanned extubations
A nurse-led initiative at a New Jersey hospital reversed an upward trend of unplanned extubation rates in its medical intensive care unit (MICU) and maintained the improvement for five years, according to an article published in Critical Care Nurse (CCN).
In 2018, the rate of unplanned extubations in the adult medical intensive care unit (MICU) at St. Joseph's University Medical Center in Paterson, New Jersey, reached 2.0 per 100 ventilator days, surpassing the internal benchmark of 1.06. A nurse-led initiative was then implemented at the 28-bed MICU, led by Alyson Triolo and Jennifer Ricker, with the support of an interprofessional team.
The program employed a three-level algorithm to identify patients at high risk for unplanned extubation, revised standards of care, and enhanced staff awareness and education. Key measures included proper patient positioning, daily rounds, patient high-risk status notifications, family education, ventilator liberation, and restraint modifications.
Post-event reviews were conducted to foster a culture of safety. Over a five-year period from 2018 to 2023, the rate of unplanned extubations decreased to below 0.7 per 100 ventilator days, with only 24% of the 343 events requiring reintubation. The initiative also led to an increased use of mitten restraints when warranted, which reduced reintubation incidents.
The program's success is attributed to evidence-based interventions, communication, teamwork, and education, with the signs of high-risk status now a visible part of the MICU environment.
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