{"id":{"repo_id":"arizona-thes","oai_identifier":"oai:repository.arizona.edu:10150/670815"},"canonical_url":"https://search.dev.ndltd.org/etd/arizona-thes/oai:repository.arizona.edu:10150/670815","repository":{"repo_id":"arizona-thes","name":"University of Arizona","base_url":"https://repository.arizona.edu/oai/request"},"display":{"title":"Reducing Unplanned Extubations in the Intensive Care Unit With Evidence-Based Practice Recommendations","abstract":"Purpose: The purpose of the quality improvement (QI) project was to analyze a deidentified datasetof unplanned extubations (UEs) events throughout Banner Health's academic hospitals in 2021, complete a literature analysis, and provide evidence-based recommendations (EBR) to Banner Health. Background: Mechanical ventilation through endotracheal intubation is a common intervention in intensive care units (ICUs) to address acute respiratory distress. UEs lead to complications and increased healthcare costs. The incidence of UE is associated with risk factors, including patient- related factors and clinical practice gaps. Within the context of Banner Health’s academic medicine division, a needs assessment found addressing UEs is crucial. Methodology: An extensive literature search and analysis on UEs in adult ICUs was completed. Once Banner Health’s RDC was approved, data analysis was completed. Data was manually tallied on a dataset recording Excel document. A formal EBR was provided to the Banner Health system to improve UE incidence. Results: Self-extubations (SEs) significantly outweigh accidental extubations (AEs), accounting for 97% of the 70 reported events. BUMCP reported the highest number of UEs. Night shift accounted for the majority of UEs, approximately 54%, with a substantial portion occurring within two hours of shift transitions. Concerns regarding physical restraint use, sedation, and staffing were prevalent in the data. Most UEs did not require immediate reintubation; one event resulted in a patient fatality. Conclusions: The EBR to Banner Health is that current practices be evaluated -- including nurse staffing/characteristics, pain management, sedation/agitation management, and delirium management and education be delivered to nursing staff to address the risk factors. The ICU Liberation Bundle and PADIS guidelines guide these continuous quality improvement efforts.","abstract_html":"Purpose: The purpose of the quality improvement (QI) project was to analyze a deidentified datasetof unplanned extubations (UEs) events throughout Banner Health's academic hospitals in 2021, complete a literature analysis, and provide evidence-based recommendations (EBR) to Banner Health. Background: Mechanical ventilation through endotracheal intubation is a common intervention in intensive care units (ICUs) to address acute respiratory distress. UEs lead to complications and increased healthcare costs. The incidence of UE is associated with risk factors, including patient- related factors and clinical practice gaps. Within the context of Banner Health’s academic medicine division, a needs assessment found addressing UEs is crucial. Methodology: An extensive literature search and analysis on UEs in adult ICUs was completed. Once Banner Health’s RDC was approved, data analysis was completed. Data was manually tallied on a dataset recording Excel document. A formal EBR was provided to the Banner Health system to improve UE incidence. Results: Self-extubations (SEs) significantly outweigh accidental extubations (AEs), accounting for 97% of the 70 reported events. BUMCP reported the highest number of UEs. Night shift accounted for the majority of UEs, approximately 54%, with a substantial portion occurring within two hours of shift transitions. Concerns regarding physical restraint use, sedation, and staffing were prevalent in the data. Most UEs did not require immediate reintubation; one event resulted in a patient fatality. Conclusions: The EBR to Banner Health is that current practices be evaluated -- including nurse staffing/characteristics, pain management, sedation/agitation management, and delirium management and education be delivered to nursing staff to address the risk factors. The ICU Liberation Bundle and PADIS guidelines guide these continuous quality improvement efforts.","abstract_has_math":false,"creators":["Lebowitz, Lauren Amie"],"institution":"The University of Arizona.","degree_name":"D.N.P.","degree_level":"doctoral","degree_discipline":"Graduate College","degree_department":null,"school":null,"contributors":[],"advisors":["Prettyman, Allen","Hunter, Jennifer"],"committee_chairs":[],"committee_members":["Johnson, Karen"],"year":2023,"date_issued":"2023","date_published":"2023","updated_at":"2026-07-24T00:55:10Z","subjects":["Accidental Extubations","Adult ICUs","ICU Liberation Bundle","Self Extubations","Unplanned Extubations"],"languages":["en"],"rights":["Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction, presentation (such as public display or performance) of protected items is prohibited except with permission of the author."],"rights_urls":["http://rightsstatements.org/vocab/InC/1.0/"],"identifier_entries":[]},"links":{"outbound_url":"http://hdl.handle.net/10150/670815","outbound_label":"Handle","outbound_source":"dc:identifier.uri"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor.advisor","label":"Advisor","values":["Prettyman, Allen","Hunter, Jennifer"]},{"key":"dc:contributor.committeemember","label":"Committee Member","values":["Johnson, Karen"]},{"key":"dc:creator","label":"Author","values":["Lebowitz, Lauren Amie"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date.accessioned","label":"Dc Date Accessioned","values":["2024-01-27T18:57:49Z"]},{"key":"dc:date.available","label":"Dc Date Available","values":["2024-01-27T18:57:49Z"]},{"key":"dc:date.issued","label":"Date","values":["2023"]},{"key":"dc:publisher","label":"Institution","values":["The University of Arizona."]},{"key":"dc:type","label":"Dc Type","values":["Electronic Dissertation","text"]},{"key":"thesis:degree_discipline","label":"Discipline","values":["Graduate College","Nursing"]},{"key":"thesis:degree_level","label":"Degree Level","values":["doctoral"]},{"key":"thesis:degree_name","label":"Degree Name","values":["D.N.P."]},{"key":"thesis:institution_name","label":"Thesis Institution Name","values":["University of Arizona"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["Accidental Extubations","Adult ICUs","ICU Liberation Bundle","Self Extubations","Unplanned Extubations"]}]},{"id":"language_rights","label":"Language and Rights","entries":[{"key":"dc:language.iso","label":"Language (ISO)","values":["en"]},{"key":"dc:rights","label":"Dc Rights","values":["Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction, presentation (such as public display or performance) of protected items is prohibited except with permission of the author."]},{"key":"dc:rights.uri","label":"Rights URI","values":["http://rightsstatements.org/vocab/InC/1.0/"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier.uri","label":"Identifier URI","values":["http://hdl.handle.net/10150/670815"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description.abstract","label":"Abstract","values":["Purpose: The purpose of the quality improvement (QI) project was to analyze a deidentified datasetof unplanned extubations (UEs) events throughout Banner Health's academic hospitals in 2021, complete a literature analysis, and provide evidence-based recommendations (EBR) to Banner Health. Background: Mechanical ventilation through endotracheal intubation is a common intervention in intensive care units (ICUs) to address acute respiratory distress. UEs lead to complications and increased healthcare costs. The incidence of UE is associated with risk factors, including patient- related factors and clinical practice gaps. Within the context of Banner Health’s academic medicine division, a needs assessment found addressing UEs is crucial. Methodology: An extensive literature search and analysis on UEs in adult ICUs was completed. Once Banner Health’s RDC was approved, data analysis was completed. Data was manually tallied on a dataset recording Excel document. A formal EBR was provided to the Banner Health system to improve UE incidence. Results: Self-extubations (SEs) significantly outweigh accidental extubations (AEs), accounting for 97% of the 70 reported events. BUMCP reported the highest number of UEs. Night shift accounted for the majority of UEs, approximately 54%, with a substantial portion occurring within two hours of shift transitions. Concerns regarding physical restraint use, sedation, and staffing were prevalent in the data. Most UEs did not require immediate reintubation; one event resulted in a patient fatality. Conclusions: The EBR to Banner Health is that current practices be evaluated -- including nurse staffing/characteristics, pain management, sedation/agitation management, and delirium management and education be delivered to nursing staff to address the risk factors. The ICU Liberation Bundle and PADIS guidelines guide these continuous quality improvement efforts."]},{"key":"dc:title","label":"Title","values":["Reducing Unplanned Extubations in the Intensive Care Unit With Evidence-Based Practice Recommendations"]}]}],"canonical_facts":{"dc:contributor.advisor":["Prettyman, Allen","Hunter, Jennifer"],"dc:contributor.committeemember":["Johnson, Karen"],"dc:creator":["Lebowitz, Lauren Amie"],"dc:date.accessioned":["2024-01-27T18:57:49Z"],"dc:date.available":["2024-01-27T18:57:49Z"],"dc:date.issued":["2023"],"dc:description.abstract":["Purpose: The purpose of the quality improvement (QI) project was to analyze a deidentified datasetof unplanned extubations (UEs) events throughout Banner Health's academic hospitals in 2021, complete a literature analysis, and provide evidence-based recommendations (EBR) to Banner Health. Background: Mechanical ventilation through endotracheal intubation is a common intervention in intensive care units (ICUs) to address acute respiratory distress. UEs lead to complications and increased healthcare costs. The incidence of UE is associated with risk factors, including patient- related factors and clinical practice gaps. Within the context of Banner Health’s academic medicine division, a needs assessment found addressing UEs is crucial. Methodology: An extensive literature search and analysis on UEs in adult ICUs was completed. Once Banner Health’s RDC was approved, data analysis was completed. Data was manually tallied on a dataset recording Excel document. A formal EBR was provided to the Banner Health system to improve UE incidence. Results: Self-extubations (SEs) significantly outweigh accidental extubations (AEs), accounting for 97% of the 70 reported events. BUMCP reported the highest number of UEs. Night shift accounted for the majority of UEs, approximately 54%, with a substantial portion occurring within two hours of shift transitions. Concerns regarding physical restraint use, sedation, and staffing were prevalent in the data. Most UEs did not require immediate reintubation; one event resulted in a patient fatality. Conclusions: The EBR to Banner Health is that current practices be evaluated -- including nurse staffing/characteristics, pain management, sedation/agitation management, and delirium management and education be delivered to nursing staff to address the risk factors. The ICU Liberation Bundle and PADIS guidelines guide these continuous quality improvement efforts."],"dc:identifier.uri":["http://hdl.handle.net/10150/670815"],"dc:language.iso":["en"],"dc:publisher":["The University of Arizona."],"dc:rights":["Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction, presentation (such as public display or performance) of protected items is prohibited except with permission of the author."],"dc:rights.uri":["http://rightsstatements.org/vocab/InC/1.0/"],"dc:subject":["Accidental Extubations","Adult ICUs","ICU Liberation Bundle","Self Extubations","Unplanned Extubations"],"dc:title":["Reducing Unplanned Extubations in the Intensive Care Unit With Evidence-Based Practice Recommendations"],"dc:type":["Electronic Dissertation","text"],"thesis:degree_discipline":["Graduate College","Nursing"],"thesis:degree_level":["doctoral"],"thesis:degree_name":["D.N.P."],"thesis:institution_name":["University of Arizona"]},"updated_at":"2026-07-24T00:55:10Z"}