Prevention of neonatal unplanned extubations in the neonatal intensive care unit: a best practice implementation project

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Adverse events of mechanically ventilated neonates such as unplanned extubations may be associated with serious negative outcomes. Unplanned extubation rates have been monitored by many neonatal intensive care units as a quality of care metric.


The objective was to implement evidence-based best practice and assess the effects of these strategies on minimizing unplanned extubation in the neonatal intensive care unit in a large tertiary children's hospital.


Evidence-based audit criteria were used to conduct an audit in the neonatal intensive care unit, Children's Hospital of Fudan University, Shanghai. The program included three phases and was conducted from May 2016 to October 2016. The Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice audit tools for promoting change in health practice were used to ascertain compliance with the criteria before and after the implementation of best practice.


Compared with the baseline audit, the follow-up audit results demonstrated increased compliance rates for securement procedures, documentation of position and security of the endotracheal tube. Compliance for standardized care practice documentation increased from 0% to 100%; compliance for standard care practice implementation increased from 0% to 54.9%; and compliance for staff education increased from 66.7% to 100%. The neonatal intensive care unit also achieved the benchmark of less than one UE per 100 intubation days.


This implementation project achieved a significant improvement in establishing evidence-based prevention of unplanned extubations in the neonatal intensive care unit of Children's Hospital of Fudan University, China. Standardizing the procedures represented an important step toward refining the quality improvement process.

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