Sample Paper on Quality Improvement-Unplanned Extubations

Quality Improvement-Unplanned Extubations in the Pediatric Intensive Care Unit

Quality improvement

In the past few years, there have been some researches that have been conducted among children, covering factors together with the consequences that are related to the unplanned extubation. However, for the purpose of this paper, quality improvement in regards to the unplanned extubations in the pediatric intensive care unit shall be emphasized and addressed. The strategic quality improvement program that this paper is trying to address is called Plan-Do-Check-Act. Most importantly, this program has been supported by the Institute of Medicine (IOM) as one of the methods of improving health conditions at the pediatrician department. In this program, monitoring of the unexpected extubation in the pediatrician intensive care unit would be conducted with the aim of coming up with relevant improvement strategies (Kang & Yu, 2014).

The study populations for this unplanned extubation are children under the age of six years.  The period of the study would be three years. Most strikingly, those that would take part in this study would be children that have experienced displacement of the endotracheal tube that has been successfully diagnosed by the relevant medical practitioner. However, any form of unplanned extubation would be accepted such as self-extubation or even accidental extubation. However, the study would exclude both tracheostomy ventilation extubation as well as the non-invasive extubation (Kang & Yu, 2014).

Selected practice issue

In most cases, mechanical ventilation is characterized by lifesaving; however, it is also associated with the other life-threatening conditions. These life-threatening conditions come about because of the related therapies as well as the mechanical ventilation itself. Examples of these related conditions include pneumonia that are related to the ventilator, lung injury that is induced by the ventilator, together with the polyneuropathy illnesses. However, the most common life-threatening condition that is associated with the mechanical ventilation is the unplanned extubation. Unplanned extubation is the condition where the mechanical ventilation experiences sudden but unexpected dislodgement that exposes the patient to either serious harm or even death (Koh & Nam, 2013). The practice issue that has been selected for the management and early detection of the unplanned extubation is the Confusion Assessment Method-Intensive Care Unit, which is simply abbreviated simply as (CAM-ICU)

Model for Quality Improvement

Numerous researchers have undertaken rigorous studies to assess the potential risk factors as well as the opportunities that can be critical in the prevention and quality improvement of the unplanned extubation in the pediatrician intensive care unit. The main undoing in the management and prevention of the unplanned extubation in the pediatrician intensive care unit is a lack of adequate sedation strategies. The Plan, Do, Check, Act methodology accomplishes a harmony between the frameworks and behavioral parts of the administration. It additionally regards wellbeing and security administration as an essential piece of good administration at large, instead of as a stand-alone framework. It is a change strategy that encompasses four stages namely plan, do, check, and finally check. These four stages would be discussed separately as below (Koh & Nam, 2013).

Change theory: The Plan, Do, Check, Act methodology


At this stage, the implementers are tasked with considering where they are to where they are supposed to be. Therefore, they perform the actual planning of by outlining what they need to accomplish. As a result, the implementers will decide who will be in charge of what and how they will accomplish their strategy. Most importantly, planning also encompasses ways of determining how to quantify the overall progress of the strategy. This would mean that an implementing team of the Quality Improvement-unplanned extubations in the pediatric intensive care unit has to be instituted to undertake the planning process. During the instituting of the implementation team, care must be taken to ensure that those chosen how the technical expertise, as well as the required commitments to enable them, exercises the implementation process accordingly (Milgram, 2013).


This is the second stage where the actual evaluation and strategy for the task in question are brainstormed and formulated. At this stage, analysis and evaluation of the subject matter are undertaken with the aim of coming up with the most appropriate way of resolving it. In addition, it is also at this stage where any potential risk that can result from the implementation of the strategy is pre-determined, and the relevant solution is sourced well in advance. This is important because it ensures that the chosen strategy is safe and cannot be a safety concern upon implementation. Therefore, the team of the Quality Improvement-unplanned extubations in the pediatric intensive care unit have to take this stage as a way of analyzing and evaluating of the issue at hand as a way of increasing its eventual successful implementation (Milgram, 2013).


This is the third stage of the implementation process. It involves analyzing the actual implementation process. The aim of this stage is to counter check whether the implementation process is taking place according to the plan. Furthermore, this stage is also vital in ensuring that the implementation process is conducted within the time line as well as the budgeted resources.


This final process involves the actual realization of the plan. Involves ensuring that all the objectives are realized. It also encompasses exploitation of the available resources effectively as a way of accomplishing the strategy at stake. In this paper, the task at stake is the quality improvement in regards to the unplanned extubations in the pediatric intensive care unit. Therefore, the activities that would take place at this stage include data collection, analysis, and interpretation (Milgram, 2013).


The success of this study relies on the careful data collection, data analysis, and interpretation. The gathered data would be reported using the famous non-patient identifiable format. However, all of the events that would be undertaken during the whole process would be approved by the research committee ethics. This implies that the implementation committee would work hand in hand with the research ethics committee as a way of dispelling any risks of engaging in any unethical practices that can jeopardize the credibility of the entire process (Marcin et al, 2013).

Resources: Human, Structural, and Financial

The human resources that are involved in the implementation of this strategy include the following: nurse manager, a duty nurse, and the children patients. Each one of the parties has a particular role as far as the Implementation of the (CAM-ICU) strategy is concerned. To begin with, the nurse manager has a role in overseeing the training session of the new nurses who would ensure the implementation of the (CAM-ICU) strategy. The nurse manager is also tasked with assigning the duty nurses specific roles and supervising to ensure that the strategy the progress smoothly as planned. During the supervision, the nurse manager ensures that the implementation of the (CAM-ICU) strategy is done accordingly. The nurse on duty is the actual caregiver to the patient. He or she has the responsibility of implementing the strategy depending on the patient condition, treatment regime, and the general response of the patient to the administered medication in the pediatrician intensive care unit (Copeland, 2012).

To achieve all these, the duty nurse must undertake close observation of the patient and if possible perform an oral interview with the aim of getting to know the exact patient condition. On the other hand, the patient is the key player of this strategy. His role is to communicate accurately about his or her wellbeing to the duty nurse.

Another resource needed for the implementation of this strategy is the finance. Finance would be required to facilitate the implementation process in totality. Finance would be needed to pay for the services of all the human resources that are participating in the project. Moreover, the finances would also be required for purchasing all of the materials and medical items that would be used in the implementation of the strategy. Besides, the finance would also facilitate the training session by securing the room and the materials for the training sessions.

Evaluation of Quality Measures

The help of the Stata conducted the statistical evaluation and analysis of data. In the calculation of the unplanned extubation, the denominator that was used formed the hours that were spent during the process of intubating the patients. After calculating the rate of the extubation, it is then expressed into a percentage. This was done by multiplying the rate by one hundred, which was then divided by twenty-four (Rachman et al, 2010). The next step was to determine the confidential interval. The help of the normal approximation purposefully for the binomial distribution did this. The next step was that the data was converted to continuous form and the data converted to the standard deviation and the median. From the analysis, it could be concluded that less than one in every one hundred children that are intubated can be successfully corrected. However, the study also revealed that there are factors that can increase the risk of the unplanned extubation. Most importantly, there is an urgent need for the further research to be able to come up with the better ways of improving the quality of the unplanned extubations in the pediatric intensive care unit (Marcin et al, 2013).



Unplanned extubation (UEX) can be described to be a potential risk especially for the infants that are in dire need for the artificial airways. Although the risk is very high, it is important to note that artificial airways are very common, particularly in the form of intensive care units, as a way of saving precious lives.  One of the potential risks of this practice is the unforeseen dislodgement of the introduced airways that can result into the health complications and even death incase no drastic measure is not taken. From the above discussed quality improvement initiative, it can be argued that when effectively implemented can reverse the alarming trends of the unplanned extubations that have been witnessed in the recent past.


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