Development of Standardized Extubation Guidelines in a Medical Intensive Care Unit

POSTER

Development of standardized extubation guidelines in a medical intensive care unit Ben Bradford, RN, BSN, CCRN, DNP-Student PURPOSE (or AIMS) Purpose: The purpose was to create and promote a guideline to be utilized by nursing staff to advocate for planned extubation in appropriate echanically-ventilated patients. The guideline also functions as an educational tool for nursing and medical staff. Project Objectives: 1.Create clinical guidelines to promote early planned extubation in MICU. Review root cause analysis of selfextubation events. 2 Present guidelines to the medical directors and nursing administration for possible implementation on the unit. 3. Provided education for controlled extubation guidelines to unit nursing staff in order to facilitate guideline implementation on the unit AIMS 4. Submit project findings for presentation to a Continuing Medical Education conference. BACKGROUND DEVELOPED GUIDELINE GRAPHIC METHODS Developed guideline -Performed literature review. -Obtained IRB approval for patient chart/data review -Evaluated incident reports of SE events from July 2015-February 2017 Performed root cause analysis by analying data of SE events and evaluating contributing factors -Feedback from content experts, project chair, nursing management, unit staff considered in guideline development. -Patient population considered in guideline Promote education/adaptation Developed education for unit staff to use at staff meeting Will promote facilitation of guideline into daily unit practice GRAPHIC BACKGROUND Mechanical ventilation (MV) -Can support or completely control breathing PROCEDURES -Indications for MV include respiratory failure, altered LOC, inability to maintain airway patency. -Frequently used in ICU patients Self Extubation (SE) -Event in which an intubated patient receiving mechanical ventilation prematurely removes the endotracheal tube. Problems with prolonged MV -Prolonged intubation is associated with adverse health outcomes, greater hospital LOS, and greater cost. Implementation unit -Implementation at a 25 bed medical ICU in urban Utah -Recent eight bed expansion -New nursing and APC staff -Teaching unit with rotating medical housestaff. -No standardized process currently exists. -Goal for unit SE was 10 or fewer incidents for FY 2016. 17 occurred. CONCLUSIONS/IMPLICATIONS Based on a review of the medical record, 16 out of 23 patients who had a SE event did not require reintubation within 48 hours, or 69.5%, indicating the majority of these patients could have been extubated earlier. 1 Preventing SE is not the only reason to promote early extubation, as many adverse health outcomes can also be avoided with reduced ventilator time. ACKNOWLEDGEMENTS APHIC GRAPHIC Project Chair: Kristi Kissell, DNP, APRN, A-G ACNP Program Director: Denise Ward, DNP, APRN, A-G ACNP Content Experts: Nathan Hatton, MD Katherine Layne, BSN, RN, CCRN Program Director: Denise Ward, DNP, APRN, A-G ACNP i The guideline promotes multidisciplinary approach and standardization between medical, nursing, and respiratory therapy teams to facilitate discontinuation of MV.