Prevention of Unplanned Extubation in Pediatric Intensive Care Units

Objectives: This quality improvement project aimed to increase nurse and provider adherence to a sedation protocol and evaluate whether improved adherence impacts unplanned extubation (UE) rates in a pediatric intensive care unit (PICU). Design: The Systems Accident Model was used to increase adherence with the current sedation protocol to reduce UE rate. A pre-post intervention design was used to assess changes in adherence and UE rates following structured staff education. Nursing adherence to sedation goal documentation and UE rates were analyzed pre- and post-nursing education, while provider adherence to ordering the protocol and UE rates were assessed pre- and post-provider education. Setting: A PICU at a children’s hospital in the Southwest United States. Subjects: 262 intubated pediatric patients in the PICU; PICU nurses and providers. Interventions: Staff education was implemented in two phases. Provider education emphasized patient eligibility and how to order the protocol, while nursing education focused on use of the protocol and documenting SBS goals. Education was provided in person, and PowerPoint presentations were sent to staff who did not attend. Human subjects were protected in this quality improvement project as confirmed by IRB approval. Measurements and main results: The primary outcome was UE rates post-intervention. Secondary outcomes included adherence to sedation score documentation and protocol ordering. Data were collected two months before and after each educational intervention through chart reviews. No statistically significant changes in adherence or UE rates were observed. Conclusions: While structured education on sedation protocol adherence did not yield significant improvements in UE rates, extended data collection periods may be necessary to detect meaningful changes.