PMID- 27694281
OWN - NLM
STAT- MEDLINE
DCOM- 20170626
LR  - 20181113
IS  - 1098-4275 (Electronic)
IS  - 0031-4005 (Print)
IS  - 0031-4005 (Linking)
VI  - 138
IP  - 4
DP  - 2016 Oct
TI  - Interventions to Improve Patient Safety During Intubation in the Neonatal 
      Intensive Care Unit.
LID - e20160069
AB  - OBJECTIVE: To improve patient safety in our NICU by decreasing the incidence of 
      intubation-associated adverse events (AEs). METHODS: We sequentially implemented 
      and tested 3 interventions: standardized checklist for intubation, premedication 
      algorithm, and computerized provider order entry set for intubation. We compared 
      baseline data collected over 10 months (period 1) with data collected over a 
      10-month intervention and sustainment period (period 2). Outcomes were the 
      percentage of intubations containing any prospectively defined AE and intubations 
      with bradycardia or hypoxemia. We followed process measures for each 
      intervention. We used risk ratios (RRs) and statistical process control methods 
      in a times series design to assess differences between the 2 periods. RESULTS: 
      AEs occurred in 126/273 (46%) intubations during period 1 and 85/236 (36%) 
      intubations during period 2 (RR = 0.78; 95% confidence interval [CI], 0.63-0.97). 
      Significantly fewer intubations with bradycardia (24.2% vs 9.3%, RR = 0.39; 95% 
      CI, 0.25-0.61) and hypoxemia (44.3% vs 33.1%, RR = 0.75, 95% CI 0.6-0.93) 
      occurred during period 2. Using statistical process control methods, we 
      identified 2 cases of special cause variation with a sustained decrease in AEs 
      and bradycardia after implementation of our checklist. All process measures 
      increased reflecting sustained improvement throughout data collection. 
      CONCLUSIONS: Our interventions resulted in a 10% absolute reduction in AEs that 
      was sustained. Implementation of a standardized checklist for intubation made the 
      greatest impact, with reductions in both AEs and bradycardia.
CI  - Copyright (c) 2016 by the American Academy of Pediatrics.
FAU - Hatch, L Dupree
AU  - Hatch LD
AD  - Divisions of Neonatology and leon.d.hatch@vanderbilt.edu.
FAU - Grubb, Peter H
AU  - Grubb PH
AD  - Divisions of Neonatology and.
FAU - Lea, Amanda S
AU  - Lea AS
AD  - Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee.
FAU - Walsh, William F
AU  - Walsh WF
AD  - Divisions of Neonatology and.
FAU - Markham, Melinda H
AU  - Markham MH
AD  - Divisions of Neonatology and.
FAU - Maynord, Patrick O
AU  - Maynord PO
AD  - Critical Care, Department of Pediatrics, Vanderbilt University Medical Center, 
      Nashville, Tennessee.
FAU - Whitney, Gina M
AU  - Whitney GM
AD  - Department of Anesthesiology, Children's Hospital of Colorado, Aurora, Colorado.
FAU - Stark, Ann R
AU  - Stark AR
AD  - Divisions of Neonatology and.
FAU - Ely, E Wesley
AU  - Ely EW
AD  - Division of Allergy, Pulmonary, and Critical Care Medicine, Department of 
      Medicine, and the Center for Health Services Research, Vanderbilt University 
      School of Medicine, Nashville, Tennessee; and Veterans Affairs Tennessee Valley 
      Geriatric Research Education and Clinical Center (GRECC), Nashville, Tennessee.
LA  - eng
GR  - T32 HD068256/HD/NICHD NIH HHS/United States
GR  - UL1 TR000445/TR/NCATS NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
DEP - 20160921
PL  - United States
TA  - Pediatrics
JT  - Pediatrics
JID - 0376422
SB  - IM
MH  - Female
MH  - Humans
MH  - Infant
MH  - Infant, Newborn
MH  - Intensive Care Units, Neonatal/statistics & numerical data
MH  - Intubation, Intratracheal/adverse effects/*methods
MH  - Male
MH  - Patient Safety/*standards
PMC - PMC5051203
COIS- POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential 
      conflicts of interest to disclose.
EDAT- 2016/10/04 06:00
MHDA- 2017/06/27 06:00
PMCR- 2017/10/01
CRDT- 2016/10/04 06:00
PHST- 2016/05/10 00:00 [accepted]
PHST- 2016/10/04 06:00 [entrez]
PHST- 2016/10/04 06:00 [pubmed]
PHST- 2017/06/27 06:00 [medline]
PHST- 2017/10/01 00:00 [pmc-release]
AID - peds.2016-0069 [pii]
AID - 10.1542/peds.2016-0069 [doi]
PST - ppublish
SO  - Pediatrics. 2016 Oct;138(4):e20160069. doi: 10.1542/peds.2016-0069. Epub 2016 Sep 
      21.