Use ISBAR Communication Tool to Reduce the Rate of Unplanned Endotracheal Extubation in Neonates

2.50
Hdl Handle:
http://hdl.handle.net/10755/621712
Category:
Full-text
Format:
Text-based Document
Type:
Poster
Level of Evidence:
N/A
Research Approach:
N/A
Title:
Use ISBAR Communication Tool to Reduce the Rate of Unplanned Endotracheal Extubation in Neonates
Author(s):
Chen, Shun-Lin
Lead Author STTI Affiliation:
Tau Theta
Author Details:
Shun-Lin Chen, BS, RN, Professional Experience: 1988-present--Kaohsiung Medical University Hospital,Neonatal Intensive Care Unit nurse. How to improve the care of quality in neonatal care is my clinical interest. 2004-2006 graduated from school of Nursing, Kaohsiung Medical University, 2006. Author Summary: My working experience is more than 20 years in pediatric field. I entered to university again, and was graduated from school of Nursing, Kaohsiung Medical University, 2006. After that, I am devoting in neonatal intensive care. How to improve the care of quality in neonatal care is my clinical interest.
Abstract:

Purpose:

 Patients with unplanned endotracheal extubation have a higher mortality rate if re-intubation is required. We expect unplanned extubation is reduced to 0% after implementation of quality improvement in our neonatal intensive care unit.

Methods:

 Implementation of quality improvement included: 1. Reform the fixation method of endotracheal tube. Elastic adhesive tape is divided into 3 phalanges or 2 phalanges with different length. We set up a table by weight to decide the number and length of phalanges, and take a video to demonstrate how to fix endotracheal tube by different phalanges of elastic adhesive tape. We replace a new elastic adhesive tape every 2 days or when wet tape is noted. 2. We revise “endotracheal tube care guide book”, and also formulate "security of endotracheal tube assessment form", to promote the nursing staff to confirm the depth of the endotracheal tube and to perform auscultation of breath sounds. 3 Promote the nursing staffs to use “N-PASS: Neonatal Pain, Agitation and Sedation Scale" to evaluate pain, restlessness for intubated babies. If N-PASS is ≧ 3 points, the physician is called to deal with this condition. We also use ISBAR tool at hand-off communication every shift. 4. Set up neonatal positioning guide and also encourage the use of pacifiers to achieve greater comfort of each intubated infant. 5. Consider early extubation according to VAP Buddle daily assessment. 6. Arrange education and training of patients’ safety.

 Results:

There is improvement of the care of endotracheal tube after implementation of quality improvement. However, we found out that evaluation of N-PASS was difficult to be applied because attending physicians is worried that sedation analgesics easily lead to neonatal respiratory depression, which may result in delayed extubation. They recommended to use “containment” and oral sugar to pain relief. if fail, we will further consider use of sedatives.

After implementation of quality improvement, we still did not reach the target value of 0%. In February 2016, there was an unplanned endotracheal extubation occurred in the night. The physician assessed that there was no need for re-intubation, and nasal continuous positive pressure was decided to use. We carried out this case by RCA approach to explore the reasons and found that we did not have an endotracheal extubation program guideline. Therefore, this will be the future direction of improvement.

Conclusion:

The project will continue to work to reduce unplanned endotracheal extubation, which aims to maintain patient safety, and improve quality of care, enhancing the communication and collaboration between healthcare teams.

Keywords:
ISBAR Communication; Neonatal Intensive Care; Unplanned Endotracheal Extubation
Repository Posting Date:
7-Jul-2017
Date of Publication:
7-Jul-2017
Other Identifiers:
INRC17PST78
Conference Date:
2017
Conference Name:
28th International Nursing Research Congress
Conference Host:
Sigma Theta Tau International
Conference Location:
Dublin, Ireland
Description:
Event Theme: Influencing Global Health Through the Advancement of Nursing Scholarship

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryFull-texten
dc.formatText-based Documenten
dc.typePosteren
dc.evidence.levelN/Aen
dc.research.approachN/Aen
dc.titleUse ISBAR Communication Tool to Reduce the Rate of Unplanned Endotracheal Extubation in Neonatesen_US
dc.contributor.authorChen, Shun-Linen
dc.contributor.departmentTau Thetaen
dc.author.detailsShun-Lin Chen, BS, RN, Professional Experience: 1988-present--Kaohsiung Medical University Hospital,Neonatal Intensive Care Unit nurse. How to improve the care of quality in neonatal care is my clinical interest. 2004-2006 graduated from school of Nursing, Kaohsiung Medical University, 2006. Author Summary: My working experience is more than 20 years in pediatric field. I entered to university again, and was graduated from school of Nursing, Kaohsiung Medical University, 2006. After that, I am devoting in neonatal intensive care. How to improve the care of quality in neonatal care is my clinical interest.en
dc.identifier.urihttp://hdl.handle.net/10755/621712-
dc.description.abstract<p><strong>Purpose:</strong></p> <p> Patients with unplanned endotracheal extubation have a higher mortality rate if re-intubation is required. We expect unplanned extubation is reduced to 0% after implementation of quality improvement in our neonatal intensive care unit.</p> <p><strong>Methods:</strong></p> <p> Implementation of quality improvement included: 1. Reform the fixation method of endotracheal tube. Elastic adhesive tape is divided into 3 phalanges or 2 phalanges with different length. We set up a table by weight to decide the number and length of phalanges, and take a video to demonstrate how to fix endotracheal tube by different phalanges of elastic adhesive tape. We replace a new elastic adhesive tape every 2 days or when wet tape is noted. 2. We revise “endotracheal tube care guide book”, and also formulate "security of endotracheal tube assessment form", to promote the nursing staff to confirm the depth of the endotracheal tube and to perform auscultation of breath sounds. 3 Promote the nursing staffs to use “N-PASS: Neonatal Pain, Agitation and Sedation Scale" to evaluate pain, restlessness for intubated babies. If N-PASS is ≧ 3 points, the physician is called to deal with this condition. We also use ISBAR tool at hand-off communication every shift. 4. Set up neonatal positioning guide and also encourage the use of pacifiers to achieve greater comfort of each intubated infant. 5. Consider early extubation according to VAP Buddle daily assessment. 6. Arrange education and training of patients’ safety.</p> <p> <strong>Results:</strong></p> <p>There is improvement of the care of endotracheal tube after implementation of quality improvement. However, we found out that evaluation of N-PASS was difficult to be applied because attending physicians is worried that sedation analgesics easily lead to neonatal respiratory depression, which may result in delayed extubation. They recommended to use “containment” and oral sugar to pain relief. if fail, we will further consider use of sedatives.</p> <p>After implementation of quality improvement, we still did not reach the target value of 0%. In February 2016, there was an unplanned endotracheal extubation occurred in the night. The physician assessed that there was no need for re-intubation, and nasal continuous positive pressure was decided to use. We carried out this case by RCA approach to explore the reasons and found that we did not have an endotracheal extubation program guideline. Therefore, this will be the future direction of improvement.</p> <p><strong>Conclusion:</strong></p> <p>The project will continue to work to reduce unplanned endotracheal extubation, which aims to maintain patient safety, and improve quality of care, enhancing the communication and collaboration between healthcare teams.</p>en
dc.subjectISBAR Communicationen
dc.subjectNeonatal Intensive Careen
dc.subjectUnplanned Endotracheal Extubationen
dc.date.available2017-07-07T18:20:48Z-
dc.date.issued2017-07-07-
dc.date.accessioned2017-07-07T18:20:48Z-
dc.conference.date2017en
dc.conference.name28th International Nursing Research Congressen
dc.conference.hostSigma Theta Tau Internationalen
dc.conference.locationDublin, Irelanden
dc.descriptionEvent Theme: Influencing Global Health Through the Advancement of Nursing Scholarshipen
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