071 - Enhancing Patient Safety: A Quality Improvement Initiative to Reduce Unplanned Extubations in the Jacobi medical center NICU
Friday, April 25, 2025
5:30pm – 7:45pm HST
Publication Number: 71.5084
Ayesha Arshad, Jacobi Medical Center/Albert Einstein, Bronx, NY, United States; Samantha A. Angeles Perez, Jacobi Medical Center/Albert Einstein, Bronx, NY, United States; sadia Haleem, Jacobi Medical Centre Bronx Newyork, Hartsdale, NY, United States; Babina K. Nayak, Jacobi Medical Center, Danbury, CT, United States
Resident Jacobi Medical Center/Albert Einstein Bronx, New York, United States
Background: Unplanned extubations (UE) in the Neonatal Intensive Care Unit (NICU) are a significant source of morbidity, leading to complications such as hypoxia, bradycardia, and prolonged mechanical ventilation. These events disrupt the care of vulnerable neonates and can result in both short-term and long-term health risks. UEs are often associated with inadequate fixation of the endotracheal tube (ET tube), insufficient staff experience, lapses in sedation protocols, and equipment failures. Reducing UE rates is essential to improving NICU patient safety. Previous studies have shown that standardized interventions—such as enhanced staff training, improved equipment reliability, and adherence to clinical protocols—can mitigate these incidents. However, UEs remain a persistent challenge in many NICUs. This quality improvement initiative at Jacobi Medical Center NICU was aimed to address these challenges by implementing standardized ET tube fixation methods, simulation-based training, regular performance reviews, and enhanced documentation practices. The goal was to reduce UE rates and improve overall patient safety in the NICU. Objective: The goal of this quality improvement project was to reduce the rate of unplanned extubations (UE) in the NICU by implementing standardized interventions aimed at enhancing staff education, equipment reliability, and procedural adherence. Design/Methods: Interventions included standardized ET tube fixators, staff training using simulations, improved documentation practices, regular performance reviews, and adherence to sedation protocols. Data on ventilator opportunities and unplanned extubation incidents were collected monthly from January 2023 to May 2024 Results: Analysis of the data revealed a significant decrease in the unplanned extubation rate from 2.75% in 2023 to 0.65% in 2024 (up to May). Monthly variation indicated specific improvements, notably with months showing no incidents. The implemented interventions contributed to enhanced patient safety through better equipment management, staff preparedness, and adherence to clinical protocols.
Conclusion(s): The project demonstrated the effectiveness of structured quality improvement strategies in reducing unplanned extubations in the NICU. Sustained focus on education, procedural standardization, and continuous monitoring are essential to maintain and further improve patient care outcomes.
