A Quality Improvement Project to Reduce Unplanned Extubations in the Neonatal Intensive Care Unit.

BACKGROUND: Unplanned extubations (UEs) continue to be one of the most common adverse events in the neonatal intensive care unit (NICU). Management of endotracheal tubes (ETTs) can be particularly challenging in neonates due to the unique needs and physical characteristics of this patient population. PURPOSE: The purpose of this quality improvement project was to decrease the rate of UEs from 0.76 to less than 0.5 per 100 ventilator days in an urban level III NICU in the Midwest, United States. METHODS: A newly formed interprofessional team created an evidence-based, standardized, bedside nurse-led care bundle for intubations and ETT care in the NICU. This project also created standardized, clear, closed-loop communication for the transition of bedside staff at shift change. RESULTS: The UE rate decreased from 0.76 to 0 per 100 ventilator days, reaching the goal of less than 0.5 per 100 ventilator days, during the 10-week project implementation period from December 2021 to February 2022. IMPLICATIONS FOR PRACTICE AND RESEARCH: Many NICUs focus on reducing UEs due to the impact on healthcare resource utilization, acute complications, and long-term outcomes for infants. The development of a standardized, nurse-led care bundle for ETTs decreased the rate of UEs. Future research is needed to study the potential for generalization to different units and beyond the scope of the neonatal population.

Academic Output of Fellows of the American Association for Respiratory Care.

BACKGROUND: Research is critical for the advancement of respiratory care. Fellows of the American Association for Respiratory Care (FAARCs) are nominated based on their significant contributions to the respiratory care profession. Research output is potentially an important component of qualification for FAARC. The purpose of this study is to report the academic output of respiratory therapist (RT) FAARCs. METHODS: We identified FAARCs from the AARC web site. Research output was assessed by searching the Scopus and PubMed databases. We collected total research documents, citations, h-index, co-authors, and document type. We compared those with only the FAARC designation with RTs who are fellows in both the Society of Critical Care Medicine (FCCMs) and FAARC. RESULTS: We identified a total of 371 RT FAARCs, 4 RT FCCMs, and 10 with both designations. FAARCs were 70% male, 22% had a doctorate, 37% had a master's, 13% had a bachelor's, and 29% did not have a degree reported. There were no differences in sex or highest degree between FAARCs and FCCMs. FAARCs had a total of 3,724 publications and 110,207 citations while those with both designations had 1,304 publications and 43,181 citations. In Scopus, 46% of FAARCs had no publications, and 27% had ≥ 10 publications; of those with both credentials, 10% had no publications, and 70% had ≥ 10 publications. FAARCs inducted in 1998 and 1999 had significantly (P < .001) more publications than other eras. Compared to those with both credentials, FAARCs had fewer median publications (1 vs 50), lower h-index (1 vs 18), and fewer citations (1 vs 1,486), P < .001 for all. Total publications in PubMed were lower, and differences in publications were similar. CONCLUSIONS: RT FAARCs had a large number of publications and citations, although nearly half did not have any publications. Those with both FAARC and FCCM had significantly more academic output per fellow, although there are only 10 individuals with both credentials.

RT education and COVID-19 pneumonia discharge quality.

Background: There is a lack of data assessing the influence of respiratory therapist (RT) education on clinical outcomes. The primary objective of this study was to evaluate the impact of RTs holding advanced degrees or completing adult critical care competencies on discharge outcomes of patients with COVID-19 pneumonia. Study Design and Methods: This retrospective, cross-sectional study included adults with confirmed COVID-19 admitted to the hospital for at least three days between March-May 2020. The academic degree held by each RT was considered advanced (baccalaureate or higher) or associate degree. Discharge outcomes were considered good, compromised, or poor when subjects' hospital discharge was directly to home, long-term care facility/rehabilitation center, or hospice/died, respectively. A time-to-event multi-state regression model was used to determine the impact of RT academic degree and adult critical care competencies on discharge outcomes using α=0.05. Results: A total of 260 subjects (median age 59 y; 166 males) received clinical care from 132 RTs. RT median professional experience was six y (IQR 3-11), 70.8% had an advanced degree, and 70.8% completed adult critical care competencies. The time-to-event multi-state regression model showed that patients with >85% exposure to RTs with advanced degrees transitioned 3.72 times more frequently to good outcomes than RTs without advanced degrees (p=.001). Similarly, patients with >85% exposure to RTs with adult critical care competencies transitioned 5.10 times more frequently to good outcomes than RTs without adult critical care competencies (p<.001). Conclusion: Patients with COVID-19 pneumonia who received greater than 85% of their care by RTs who earned advanced degrees or completed adult critical care competencies had improved discharge outcomes. This preliminary work suggests that advancing education for the respiratory therapist workforce may improve the discharge quality of patients with acute respiratory failure and should be further explored.

Sustained Reduction of Nasal Pressure Injuries in the Neonatal Intensive Care Unit With the Use of Bubble Continuous Positive Airway Pressure: A Quality Improvement Project.

PURPOSE: The purpose of this interprofessional team-driven quality improvement project was to implement a Bubble continuous positive airway pressure (CPAP) Skincare Protocol proactively to prevent potential device-related pressure injuries. PARTICIPANTS AND SETTING: The setting was a level 3, 60-bed single patient room neonatal intensive care unit (NICU) located within a Midwest urban academic medical center with more than 200 healthcare providers. Prior to the beginning of this project, the NICU had been using the CPAP apparatus that had documented 6 nasal pressure injuries over a 6-month period. Because of ease of use, the NICU moved to using Bubble CPAP (BCPAP), which is known to place patients at a higher risk of nasal pressure injuries due to the way the apparatus sits inside the nares. APPROACH: An evidence-based practice model provided the guiding framework for the development of our BCPAP Skincare Protocol. Knowing that the unit had already documented nasal pressure injuries, the interprofessional-devised protocol was developed to decrease the risk of nasal injuries with the use of BCPAP in premature infants. The protocol was disseminated via an all-healthcare provider educational program. OUTCOMES: During the first 3 months postprotocol implementation period, one stage 2 nasal injury was noted and immediately treated and healed without incident. During the next 24-month, postimplementation period, there were zero nasal pressure injuries reported. IMPLICATIONS FOR PRACTICE: The healthcare providers found that using an interprofessional team approach in developing and implementing an evidence-based BCPAP Skincare Protocol reduced the incidence of nasal pressure injuries associated with the use of BCPAP in the NICU.