Reducing Severe Tracheal Intubation Events Through an Individualized Airway Bundle
| Autor: | Jacqueline Zedalis, Stephanie Murphy, Natalie Napolitano, Nicole Pouppirt, Elizabeth E. Foglia, Rula Nassar, Leane Soorikian, Bridget Cei, Anne Ades, Ursula Nawab, Kelle Matthews, Heidi M. Herrick, Akira Nishisaki |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_treatment
System stability Intensive Care Units Pediatric Article Risk Factors Intensive Care Units Neonatal Outcome Assessment Health Care Intubation Intratracheal Medicine Intubation Humans Registries Process Measures business.industry Tracheal intubation Outcome measures Infant Newborn Infant Medication administration Quality Improvement Anesthesia Pediatrics Perinatology and Child Health Premedication Patient Safety Airway business Patient Care Bundles |
| Zdroj: | Pediatrics |
| Popis: | BACKGROUND Neonatal tracheal intubation (TI) is a high-risk procedure associated with adverse safety events. In our newborn and infant ICU, we measure adverse tracheal intubation–associated events (TIAEs) as part of our participation in National Emergency Airway Registry for Neonates, a neonatal airway registry. We aimed to decrease overall TIAEs by 10% in 12 months. METHODS A quality improvement team developed an individualized approach to intubation using an Airway Bundle (AB) for patients at risk for TI. Plan-do-study-act cycles included AB creation, simulation, unit roll out, interprofessional education, team competitions, and adjusting AB location. Outcome measure was monthly rate of TIAEs (overall and severe). Process measures were AB initiation, AB use at intubation, video laryngoscope (VL) use, and paralytic use. Balancing measure was inadvertent administration of TI premedication. We used statistical process control charts. RESULTS Data collection from November 2016 to August 2020 included 1182 intubations. Monthly intubations ranged from 12 to 41. Initial overall TIAE rate was 0.093 per intubation encounter, increased to 0.172, and then decreased to 0.089. System stability improved over time. Severe TIAE rate decreased from 0.047 to 0.016 in June 2019. AB initiation improved from 70% to 90%, and AB use at intubation improved from 18% to 55%. VL use improved from 86% to 97%. Paralytic use was 83% and did not change. The balancing measure of inadvertent TI medication administration occurred once. CONCLUSIONS We demonstrated a significant decrease in the rate of severe TIAEs through the implementation of an AB. Next steps include increasing use of AB at intubation. |
| Databáze: | OpenAIRE |
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