Decreasing Unplanned Extubation Rates on an Adult Medical Intensive Care Unit

BACKGROUND: Decreasing unplanned extubation rates in critically ill patients is an important element of care in the intensive care unit. However, most available literature on unplanned extubation addresses its prevalence, risk factors, and patient outcomes; few articles offer specific, reproducible interventions for preventing unplanned extubation. LOCAL PROBLEM: In the adult medical intensive care unit of a large academic tertiary care hospital, the unplanned extubation rate in the last quarter of 2018 was 2.0 per 100 ventilator days, higher than the internal benchmark of 1.06 per 100 ventilator days. METHODS: A quality improvement project was initiated to identify patients' risk for unplanned extubation and implement interventions according to risk level. The risk categories and associated bundled nursing interventions were created by an expert work group using available literature and data collected on the unit. The effectiveness of the interventions was tested by continually monitoring unplanned extubation rates. RESULTS: After the project's initiation in 2019, the rate of unplanned extubations in the intensive care unit decreased from 1.307 per 100 ventilator days in 2018 to 0.344 in 2023. A 2-proportion z test revealed a significant difference in unplanned extubation rates between 2018 and 2023 (P < .001), indicating that the project implemented in 2019 effectively reduced unplanned extubation events over time. CONCLUSION: By integrating evidence-based interventions, fostering a culture of safety, and emphasizing proper patient assessment and communication, substantial progress was made in decreasing unplanned extubation rates.