2.50
Hdl Handle:
http://hdl.handle.net/10755/344124
Category:
Abstract
Type:
Poster
Title:
A Multidisciplinary Approach to Improve Rapid Sequence Intubation in Children
Author(s):
Jablonski, Tamara; Frey, Mary; Najdovski, Melissa
Lead Author STTI Affiliation:
Non-member
Author Details:
Tamara Jablonski, MSN, RN, CPN, Tami.Jablonski@cchmc.org; Mary Frey, BSN, RN, CPEN, CPN; Melissa Najdovski, BA, BSN, RN
Abstract:
Research Abstract Purpose: Rapid Sequence Intubation (RSI) is a life saving intervention utilized to obtain a definitive airway during the management of pediatric patients in respiratory failure. Oxy-hemoglobin desaturation during RSI is commonly the first sign of physiologic deterioration and may be followed by bradycardia, hypotension and cardiac arrest. In our emergency department (ED), we documented a 33% oxy-hemoglobin desaturation rate among patients undergoing RSI. Our objective was to standardize RSI and reduce process variation through the multidisciplinary use of an intervention bundle with the specific aim of reducing oxy-hemoglobin desaturation associated with the RSI process. Design: This project is a prospective quality improvement effort in a pediatric emergency department utilizing multiple Plan-Do-Study-Act (PDSA) cycles within the Model for Improvement. Setting: Large, Midwestern, urban, tertiary care children’s hospital emergency department with Level I trauma status. Participants/Subjects: Participants include registered nurses (RN), physicians, respiratory therapists, clinical leaders, improvement experts and research assistants. Subjects included all patients undergoing RSI in the ED following the bundle introduction. Methods: A multidisciplinary improvement team was organized with participants identified based on experience and expertise in the RSI process and quality improvement methods. An intervention bundle was designed to standardize the RSI process, enhance communication, and raise team-level situational awareness. The bundle included a novel RSI checklist, pilot/co-pilot model for checklist execution, restriction of laryngoscopy to specific physicians based on level of training, and use of a video laryngoscope. Key process measures included use of the RSI checklist, pre-oxygenation > 3 minutes prior to first intubation attempt, end-tidal carbon dioxide (ETCO2) detection within 20 seconds of endotracheal tube (ETT) placement, correct intubating physician and video laryngoscope use. The outcome measure was oxy-hemoglobin desaturation during the RSI process. All data was collected by a trained research assistant from video review of care provided. Change in key process and outcome measures was detected via statistical process control (SPC) charts as well as direct comparison with historical performance. Results/Outcomes: 75 pediatric patients underwent RSI in our ED after bundle introduction. Patient characteristics were similar between historical and intervention groups. Data on the 75 patients during the intervention period (July 2012-September 2013) when compared to historical data (114 patients from April 1, 2009-March 31, 2010) revealed fewer process failures, fewer desaturations (16% in intervention group compared to 33% in historical group), fewer failed intubation attempts, and increased first attempt intubation success by pediatric emergency medicine (PEM) providers. Special cause variation was noted on the control chart for our main outcome measure, patients between patients experiencing desaturation. Implications: Standardization of the RSI process has led to improved success and reduced adverse events during this critical procedure as demonstrated by decreased frequency of oxy-hemoglobin desaturation and special cause variation for patients between patients experiencing desaturation. Multidisciplinary team collaboration was vital to the development, implementation, and success of an intervention bundle used during RSI in the ED setting.
Keywords:
Intubation in Children; Rapid Sequence Intubation
Repository Posting Date:
4-Feb-2015
Date of Publication:
4-Feb-2015
Conference Date:
2014
Conference Name:
2014 ENA Annual Conference
Conference Host:
Emergency Nurses Association
Conference Location:
Indianapolis, Indiana, U.S.A.
Description:
2014 ENA Annual Conference Theme: Safe Practice, Safe Care. Held at the Indiana Convention Center
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen_GB
dc.type.categoryAbstracten_GB
dc.typePosteren_GB
dc.titleA Multidisciplinary Approach to Improve Rapid Sequence Intubation in Childrenen_GB
dc.contributor.authorJablonski, Tamaraen_GB
dc.contributor.authorFrey, Maryen_GB
dc.contributor.authorNajdovski, Melissaen_GB
dc.contributor.departmentNon-memberen_GB
dc.author.detailsTamara Jablonski, MSN, RN, CPN, Tami.Jablonski@cchmc.org; Mary Frey, BSN, RN, CPEN, CPN; Melissa Najdovski, BA, BSN, RNen_GB
dc.identifier.urihttp://hdl.handle.net/10755/344124-
dc.description.abstractResearch Abstract Purpose: Rapid Sequence Intubation (RSI) is a life saving intervention utilized to obtain a definitive airway during the management of pediatric patients in respiratory failure. Oxy-hemoglobin desaturation during RSI is commonly the first sign of physiologic deterioration and may be followed by bradycardia, hypotension and cardiac arrest. In our emergency department (ED), we documented a 33% oxy-hemoglobin desaturation rate among patients undergoing RSI. Our objective was to standardize RSI and reduce process variation through the multidisciplinary use of an intervention bundle with the specific aim of reducing oxy-hemoglobin desaturation associated with the RSI process. Design: This project is a prospective quality improvement effort in a pediatric emergency department utilizing multiple Plan-Do-Study-Act (PDSA) cycles within the Model for Improvement. Setting: Large, Midwestern, urban, tertiary care children’s hospital emergency department with Level I trauma status. Participants/Subjects: Participants include registered nurses (RN), physicians, respiratory therapists, clinical leaders, improvement experts and research assistants. Subjects included all patients undergoing RSI in the ED following the bundle introduction. Methods: A multidisciplinary improvement team was organized with participants identified based on experience and expertise in the RSI process and quality improvement methods. An intervention bundle was designed to standardize the RSI process, enhance communication, and raise team-level situational awareness. The bundle included a novel RSI checklist, pilot/co-pilot model for checklist execution, restriction of laryngoscopy to specific physicians based on level of training, and use of a video laryngoscope. Key process measures included use of the RSI checklist, pre-oxygenation > 3 minutes prior to first intubation attempt, end-tidal carbon dioxide (ETCO2) detection within 20 seconds of endotracheal tube (ETT) placement, correct intubating physician and video laryngoscope use. The outcome measure was oxy-hemoglobin desaturation during the RSI process. All data was collected by a trained research assistant from video review of care provided. Change in key process and outcome measures was detected via statistical process control (SPC) charts as well as direct comparison with historical performance. Results/Outcomes: 75 pediatric patients underwent RSI in our ED after bundle introduction. Patient characteristics were similar between historical and intervention groups. Data on the 75 patients during the intervention period (July 2012-September 2013) when compared to historical data (114 patients from April 1, 2009-March 31, 2010) revealed fewer process failures, fewer desaturations (16% in intervention group compared to 33% in historical group), fewer failed intubation attempts, and increased first attempt intubation success by pediatric emergency medicine (PEM) providers. Special cause variation was noted on the control chart for our main outcome measure, patients between patients experiencing desaturation. Implications: Standardization of the RSI process has led to improved success and reduced adverse events during this critical procedure as demonstrated by decreased frequency of oxy-hemoglobin desaturation and special cause variation for patients between patients experiencing desaturation. Multidisciplinary team collaboration was vital to the development, implementation, and success of an intervention bundle used during RSI in the ED setting.en_GB
dc.subjectIntubation in Childrenen_GB
dc.subjectRapid Sequence Intubationen_GB
dc.date.available2015-02-04T11:26:55Z-
dc.date.issued2015-02-04-
dc.date.accessioned2015-02-04T11:26:55Z-
dc.conference.date2014en_GB
dc.conference.name2014 ENA Annual Conferenceen_GB
dc.conference.hostEmergency Nurses Associationen_GB
dc.conference.locationIndianapolis, Indiana, U.S.A.en_GB
dc.description2014 ENA Annual Conference Theme: Safe Practice, Safe Care. Held at the Indiana Convention Centeren_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.en_GB
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