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G418(P) Four-fold reduction in accidental extubations in the neonatal unit-what really matters?
  1. T Moore,
  2. A Dela-Cruz,
  3. G Sunsoay,
  4. P Surana
  1. Neonatal Unit, Birmingham Heartlands Hospital, Birmingham, UK

Abstract

Background Accidental extubations (AE) in neonatal intensive care units (NICUs) can be associated with significant morbidity and mortality. Previously published studies have reported AE rates in NICUs between 0.56 to 6.6/100 intubation days.

Aims and Methods: A previous audit in our tertiary NICU between Oct 2013–Feb 2014 revealed a high AE rate of 8.05/100 intubation days. Following this audit- a uniform method of endotracheal tube (ETT) fixation (Neo-fit) was introduced. Awareness regarding AE was raised amongst both medical and nursing staff in handovers, clinical meetings and mortality reviews. Sedation was used proactively in infants who had a previous AE episode related to agitation. A prospective re-audit was conducted over a 6 month period between May and October 2015

  • To monitor AE rate and

  • To analyse the factors associated with these episodes

Results 15 AE events were recorded in 11 infants (12.5% of intubated patients) with the AE rate dropping to 2.03/100 intubation days. 54% of AE events occurred at corrected gestational age of less than 28 weeks. In 67% of the events, infant had been intubated for more than 10 days. Neo-fit fixation was used in 93% of events. The main reasons for AE were medical or nursing intervention (33%), agitation (27%) and Kangaroo care (27%). Only one event was attributed to loose fixation while in the rest, ETT dislodged after a vomit. Reintubation was required in 60% of events. 73% of episodes occurred with 1:2 nursing rather than 1:1. Events were distributed evenly between day and night.

Conclusions The re-audit demonstrated a fourfold reduction in the AE rate as compared with the previous audit. Uniform method of ETT fixation and heightened staff awareness regarding AE was instrumental in bringing the desired change. More work needs to be done regarding parental education about risk of AE during kangaroo care and ensuring appropriate nursing ratios to further minimise the AE rate in our unit. We recommend that AE rates should be routinely monitored in all NICUs to improve patient safety.

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