Abstract
Purpose: The purpose of this project was to implement and evaluate the use of an extubation checklist for mechanically ventilated (MV) patients aged 18 and older in a medical intensive care unit (MICU).|Background: The process of extubating patients is tedious with multiple clinical components to assess readiness. A nurse-led extubation policy is current practice with the MICU. With high nursing turnover, this process can be cumbersome and complex. Furthermore, despite best practices utilized in the policy, reintubation continues to occur. Reintubation results in negative clinical outcomes including increased mortality, duration of MV, and length of stay. Current expert recommendations include identifying those at high risk for extubation failure prior to extubation. Lastly, checklists are a useful tool to ensure accuracy in clinically complex tasks. It was hypothesized that a bedside checklist to ensure the completion of the current policy in addition to assessing for reintubation risk factors would enhance clinical outcomes.|Sample/Setting: Nursing staff in a large tertiary academic medical center participated in the project. A convenience sampling technique was utilized to assess endpoints among mechanically ventilated patients who met clinical criteria for checklist use.|Methods: Day nursing staff along with licensed independent practitioners were educated on the checklist. Checklists were placed at the bedside to be completed at the time of extubation. A review of the electronic medical record was completed to assess length of MV, hospital length of stay, mortality, and reintubation rates among the pre and post-implementation period.|
Results: A statistically significant decrease in hospital LOS was noted. There was no significant change in mortality, reintubation, or duration of MV between the two groups.|Conclusion: The extubation checklist should continue to be utilized to improve clinical outcomes in the medical intensive care unit.