Implementation of an Extubation Readiness Guideline for Preterm Infants

Abstract

Problem & Purpose: Intubated preterm infants ≤ 32 6/7 weeks gestation in a mid-Atlantic level IV Neonatal Intensive Care Unit (NICU) faced a high number of days on the ventilator. The literature supported that use of an extubation guideline will decrease ventilator days, and this NICU lacked a standardized extubation guideline providing criteria to drive extubation eligibility. In 2020 this NICU had 22.0% of very low birth weight (VLBW) infants on a ventilator for > 28 days, compared to a median of 15.7% infants (in this subgroup) in other similar NICUs throughout the United States (U.S.). Based on six weeks of electronic health record (EHR) chart audits of extubations in this NICU in 2021, 44% of preterm infants ≤ 32 6/7 weeks were intubated for > 28 days, with an average of 23 days on a ventilator. The purpose of this quality improvement (QI) project was to implement and evaluate the effectiveness of an extubation readiness guideline in preterm infants ≤ 32 6/7 weeks gestation in a mid-Atlantic level IV NICU. Methods: This project occurred over a 17-week period in fall of 2021. Implementation included a multidisciplinary committee formation, identification of champions, NICU staff education, guideline dissemination, completion of a guideline checklist by bedside nursing (for eligible patients), clinician reminders, and chart audits for collection of pre/post implementation data. Staff education completion, guideline use, guideline adherence, demographic patient data, ventilator days, time to first extubation, and need for reintubation were tracked. Results: Post implementation data indicated decreased: average total ventilator days, need for intubation > 28 days, and days to first extubation attempt for preterm infants ≤ 32 6/7 weeks gestation. Conclusions: Results suggested that implementation of the evidence-based guideline was effective in decreasing average total ventilator days for preterm infants ≤ 32 6/7 weeks gestation.