Unplanned extubation in a paediatric intensive care unit: impact of a quality improvement programme
Unplanned extubation in a paediatric intensive care unit: impact of a quality improvement programme
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DOI：
10.1111/j.1365-2044.2008.05628.x
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发表时间：
2008-11-01
期刊：
影响因子：
10.7
通讯作者：
de Carvalho, W. B.
中科院分区：
文献类型：
--
作者：
da Silva, P. S. L.;de Aguiar, V. E.;de Carvalho, W. B.
非计划性气管拔管是儿科重症监护病房常见的问题，是当前医疗实践中的一个重要质量问题。我们评估了Ora持续质量改进计划在5年内减少非计划性拔管发生率的有效性。经过两年的基准期后，我们制定了行动计划来解决所发现的问题。在实施该计划后，制定的解决拔管问题的行动计划从第一年的每100个插管患者日的2.9次计划外拔管下降到去年的0.6次（p = 0.0001）。这一减少是由于2岁以下儿童计划外拔管减少的结果。虽然死亡率与未经历计划外拔管的儿童相似，但计划外拔管的儿童机械通气持续时间明显更长，在重症监护室的停留时间更长，住院时间更长。我们发现，实施持续的质量改进计划是有效的，在减少非计划性拔管的总体发生率。
Unplanned tracheal extubation is an important quality issue in current medical practice as it is a common occurrence ill paediatric intensive care units. We have assessed the effectiveness Ora continuous quality improvement programme in reducing the incidence of unplanned extubation Over a 5-year period. After a 2-year baseline period, we developed action plans to address the issues identified. Following implementation of the programme, the developed action plans to address the issues extubation decreased form 2.9 unplanned extubations per 100 intubated patient days in the first year to 0.6 in the last year (p = 0.0001). This reduction was the result of a decrease in unplanned extubation in children younger than 2 years of age. Although mortality was similar to that of Children who did not experience an unplanned extubation, those with an unplanned extubation had a significantly longer duration of mechanical ventilation, longer stay in the intensive care unit, and longer hospital stay. We found that the implementation of a continuous quality improvement programme is effective in reducing the overall incidence of unplanned extubations.