title: [Reducing the Unplanned Removal Rate of Endotracheal Tubes in the Pediatric Intensive Care Unit].
abstract: OBJECTIVE
  In 2012, the rate of unexpected removal of endotracheal tubes in our pediatric intensive unit was above the maximum target level of 0.28%. We designed a survey to identify the relevant difficulties faced by nurses in order to formulate viable solutions and reduce the removal rate. After assessing the findings of this survey, we concluded that the following represented the primary difficulties: use of incorrect endotracheal tube care standards, the inadequate sedation of patients, the incorrect cognition of care of nurses, and lack of in-service education and securing techniques.
  
  
  OBJECTIVE
  After implementing quality improvements to overcome these difficulties, the rate of unexpected removal dropped dramatically to 0.57%.
  
  
  METHODS
  Our quality improvement strategy included: designing a protocol and a checklist for securing endotracheal tubes, purchasing additional waterproof tape and restraint straps, establishing a standard protocol for sedation, producing an educational DVD, and continuing in-service education.
  
  
  RESULTS
  After implementation of the above measures, the rate of unexpected removal fell dramatically from 0.76% to 0.33%. Additionally, the completion-of-care rate for patients with endotracheal tubes rose significantly from 27.2% to 94.5%.
  
  
  CONCLUSIONS
  This project established a standard procedure for caring for endotracheal tube patients; improved communication among staff members; and reduced unexpected removal events.
authors.affiliation: Department of Nursing, National Taiwan University Hospital, Taiwan, ROC.
authors.forename: Muu-Dan
authors.initials: MD
authors.lastname: Liang
authors.affiliation: Department of Nursing, National Taiwan University Hospital, Taiwan, ROC. fan5741@ntuh.gov.tw.
authors.forename: Guei-Ling
authors.initials: GL
authors.lastname: Fann
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000451:nursing
keywords: pediatric intensive care unit; procedure of care for endotracheal tube; unplanned removal rate of endotracheal tube