Introduction and aims Accidental extubations (AE) are significant risk to patient safety and can be associated with serious complications and mortality. We introduced a quality improvement programme in our tertiary neonatal intensive care unit (NICU) to decrease the incidence of this potentially preventable adverse event.

Methods An initial prospective audit was undertaken between April–July 2011 to ascertain incidence and evaluate circumstances surrounding all AE events. The causes leading to AE were medical/nursing interventions (44%), poor fixation (22%) and agitated infant (11%). No cause could be ascertained in the rest. Following this audit, a quality improvement program using multifactorial prevention strategies was implemented. This included raising awareness regarding appropriate endotracheal tube (ETT) fixation in induction, simulation scenarios and workshops, daily ETT assessment in ward rounds, increased safety and vigilance during nursing/medical procedures or during kangaroo-care and assessing the continued need of ventilation. Careful documentation and reporting of any AE event was also recommended. A subsequent re-audit was undertaken to assess its impact on the incidence of AE. During both audit periods, a uniform method (Neobar) was used for ETT fixation; however NICU’s intensive care capacity had increased by 40% prior to the reaudit.

Results A prospective re-audit between February–June 2013 showed a significant decrease in the incidence of AE by more than half to 1.14/100 ventilator days from 2.98/100 ventilator days. The reasons attributed to AE were short ETT (37.5%), agitated non-sedated infants (25%), nursing intervention (12.5%), kangaroo-care (12.5%) and delay in ETT fixation (12.5%). Three-fourths of the infants needed reintubation post-AE in both audit periods.

Conclusions Increased awareness and education of medical and nursing staff regarding AE can help decrease its occurrence significantly, thereby improving patient safety and outcomes. It should be routinely monitored as a quality of care metric in NICUs.