ACCIDENTAL EXTUBATION CONTROL A MULTIDISCIPLINARY APPROACH Project Team
ACCIDENTAL EXTUBATION CONTROL: A MULTIDISCIPLINARY APPROACH Project Team : Project Team Valéria Cabral Neves, PICU Phisiotherapist; Camila Gemin Ribas, PICU Phisiotherapist; Aline Dandara Rafael, PICU Phisiotherapist; Adriana Kosliski, Intensive Care Physician; Mônica Lima Cat, Intensive Care Physician; José Eduardo Carreiro, Intensive Care Physician. The team was made up of the staff of the paediatric intensive care unit (physiotherapists, nurses and doctors). The study was condutec at the Hospital de Clínicas of the Federal University of Paraná (UFPR) and the Post Graduate Programme on Children and Adolescents of UFPR Curitiba (PR), Brazil valeria. neves@hc. ufpr. br MEASUREMENT OF IMPROVEMENT OUR PURPOSE Identify the occurrence and the causes of accidental extubation (AE); The control and the reduction rate of accidental extubation; Improve the team performance and the quality indicators of this PICU. STRATEGY FOR CHANGE The research involved 115 intubated children. Daily data of all intubated patients was collected by a team of physiotherapists. The accidental extubation index was used to calculate the monthly rate of occurrence of AE. Whenever AE occurred an adverse event notification was reported to THE SECURITY CORE FROM HOSPITAL DE CLÍNICAS. A CHARACTERISTICS OF PATIENTS REINTUBATION RATE Were observed 25 episodes of AE. (Figure 1) Twenty one (80%) of extubations occurred during the week and 4 (20%) at the weekends. Thirteen patients (52%) were in assist-control mode of mechanical ventilation. ACCIDENTAL EXTUBATION B C REINTUBATED 25 24/25 ORAL INTUBATION ROUTE WEIGHT (lbs) FIGURE 3. the graphic A shows causes of AE during the study; the graphic B shows 18. 84 the occurrence of AE when comparing the three shifts of the multidisciplinary team; the graphic C shows that eighteen patients (72%) were reintubated after the occurrence of AE. 13, 50 MV LENGTH STAY (days) FEMALE 13/25 12 10 AGE (months) MV AFTER AE (days) 0 5 10 LESSONS LEARNT 15 20 25 FIGURE 1. Shows characteristics of patients: the number of accidental extubations; the intubation route; the median of children weight ; the length of mechanical ventilation (median); gender; age (median) and the length of mechanical ventilation after the AE (median). THE ACCIDENTAL EXTUBATION RATE Intubated daily patients Accidental extubation (month) AE rate (%) FIGURE 2. Shows the period of the study: from January to October; the number of intubaded/day patients; the number of AE montly and index of AE montly. MESSAGE There was during the period of study, a gradual reduction in the incidence of EA. Fortunately in September and October, there were no accidental extubations. Our research is still in progress and we have a long way to go. However, our study was awared the title of: “BEST PRACTICES IN CARE IN PAEDIATRIC INTESIVE CARE” at Security core from HOSPITAL DE CLÍNICAS.
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