Intubation Timeout Tool Implementation in a Level IV Neonatal Intensive Care Unit

Abstract

Problem & Purpose: Endotracheal intubation is a common lifesaving, but technically challenging procedure performed in the neonatal intensive care unit (NICU). Based on a chart review of intubations performed in a Level IV NICU, use of a timeout protocol was reported 86% of the time, and 48% of intubations were associated with at least one adverse event. In this setting, adverse events occur more often when patients are acutely unstable and when providers demonstrate variable intubation proficiency. The purpose of this quality improvement project was to implement and evaluate an evidence-based pre-procedural intubation-specific timeout tool in a Level IV NICU in order to improve neonatal intubation process consistency and safety, leading to improved patient outcomes. Methods: Project implementation occurred over a ten-week period in a 49-bed Level IV NICU. Implementation included collection of baseline data, identification of champions, staff education, and development of project resources and reminders. The intubation task-specific tool was initiated by the nursing staff for eligible intubation events and involved all intubation providers. A chart audit tool was used to extract demographic and intubation timeout tool data from the electronic health record (EHR). Results: The pre-intubation timeout tool was used for nine intubation events (60%) over the ten-week period. With implementation of the tool, the incidence of intubation-associated adverse events decreased by 8% from baseline chart review. Conclusion: Results suggest that the use of an evidence-based pre-procedural intubation-specific timeout tool improves intubation process, consistency, and safety across multiple intubating neonatal providers. Continuing education tactics are necessary to promote sustainability and accountability leading to improved patient outcomes.