CSI Summary
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CSI Project
Methodist Hospital Metropolitan (San Antonio, Texas)
CSI Summary
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CSI Presentation
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CSI Toolkit
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Unplanned extubation in adult patients
Hospital Unit(s):Medical Intensive Care Unit (MICU)
Surgical Intensive Care Unit (SICU)
CSI Participants:
Project Goals/Objectives:
Project Outcomes:
Project Overview:
According to 2020 Airway Safety Network data, unplanned extubations contribute to extended ventilator days and critical care length of stay, increased incidence of ventilator-associated pneumonia, and significant mortality. Data estimates the average cost of every unplanned extubation event to be nearly $41,000.
In 2022, 27 unplanned extubations were reported in our hospital’s adult MICU and SICU. Our CSI team decided to tackle this challenge and collaborated with a respiratory therapist to analyze the problem, identify contributing factors and develop improvement strategies.
After a thorough literature review and analysis, we developed two new tools: an unplanned extubation prevention bundle and a risk assessment wheel. The bundle provides the latest evidence-based practices for preventing unplanned extubation. The wheel identifies patients at risk of self-extubation, allowing clinicians to ensure proper allocation of the people resources and equipment necessary to maintain airway safety and prevent further complications.
Following development of these tools, our CSI team educated 95% of critical care nurses and 100% of charge nurses and clinical nurse coordinators on the prevention bundle and risk assessment wheel, respectively. Our improvement strategy using the bundle emphasized extubation of patients within two hours of passing breathing trials and achieving a high rate of bundle implementation compliance among our units’ nurses.
We collected pre-intervention data to establish a baseline through bedside audits using the Kamishibai card (or K-card) lean process. Post-intervention data showed that:
These outcomes saved our hospital a projected $83,860 annually with a 433% return on investment.
While our CSI team is pleased with these significant improvements and fiscal savings, our interventions ultimately were not enough to reduce the incidence of unplanned extubations or the calculated incidence density. However, we learned some valuable lessons and have recommended a handful of additional improvement projects.
Permission to Reuse Materials
The materials associated with this AACN Clinical Scene Investigator (CSI) Academy project are the property of the participating hospital noted above, not AACN. Requests to use content contained in the CSI team’s summary, presentation or toolkit should be directed to the hospital. We suggest reaching out to the hospital’s Communications, Marketing or Nursing Education department for assistance.
Disclaimer
The AACN CSI Academy program supports change projects based on quality improvement methods. Although CSI teams seek to ensure linkage between their project and clinical/fiscal outcomes, data cannot be solely attributed to the project and are estimations of impact.