Executive Summary Checklist
The following actionable steps should be implemented to reduce the incidence of unplanned extubation.
- Assemble a core multidisciplinary airway safety leadership team to ensure recognition of the problem and support development of systems that will eliminate unplanned extubation and its associated complications, especially preventable deaths.
- Determine baseline rate of unplanned extubation (See Metrics Section below).
- Determine baseline rate of complications (oral mucosa and facial skin pressure injuries, pneumonia, vocal cord injury, hypoxemia, brain injury, death) caused by unplanned extubation.
- Perform a root cause analysis (RCA) for all incidences of unplanned extubation.
- Utilize a multidisciplinary team including physicians, nurses and respiratory therapists to evaluate the root cause of every unplanned extubation, determine a plan to eliminate the root cause, implement the plan and track results.
- Implement the core unplanned extubation dataset as defined in the Metrics Section of this APSS.
- Every (endotracheally) intubated, mechanically ventilated patient should have the entire PSMF Core Dataset for extubation recorded in the patient’s medical chart.
- Evaluate your hospital’s Electronic Health Record (EHR) to determine if the entire core dataset is included in the EHR.
- If included, educate all providers of airway management how to properly track UE.
- If not included, contact the EHR company and request they add the dataset; Develop a system for temporarily tracking the dataset until the EHR Company institutes the dataset.
- Develop a Quality Management Process to promote and ensure continuous improvement with an initial goal of eliminating preventable deaths from unplanned extubation and ultimately eliminating all incidences of unplanned extubation.
- Require tracking and reporting of all incidences of unplanned extubation and complications of unplanned extubation (hypoxemia, pneumonia, vocal cord injury, brain injury and death).
- Provide periodic education for all airway management providers.
- Educate providers regarding the importance of prevention of unplanned extubation and the need for accurate data tracking.
- include unplanned extubation as part of every presentation of management of the difficult airway patient.
- Implement Clinical Best Practices for Preventing Unplanned Extubation.
- Standardize tracheal tube restraint devices, utilizing the most proven methods / devices.
- Implement systems for alerting clinicians to patients with a known difficult airway.
- Formalize systems for appropriate sedation and patient restraint to decrease the risk of unplanned self-extubation.
- Share successes (Best Practices) with other institutions