title: Quality Improvement Study on New Endotracheal Tube Securing Device (Neobar) in Neonates.
abstract: OBJECTIVE
  To examine the rate of unplanned extubation (UE) after the introduction of NeoBar (endotracheal tube stabilization device) compared to the previous tapping method and to analyze the factors associated with UE in the neonatal intensive care unit (NICU).
  
  
  METHODS
  A quality improvement study was conducted in a tertiary NICU between October 2011 and December 2013. In October 2012, after many educational sessions NeoBar was introduced as a tool for securing endotracheal tube. The UE rate was compared one year before and one year after the introduction of NeoBar. The UE rate was reported as UE per 100 intubation days. Statistical process control charts were used for understanding the special cause variation. The authors used Standards for Quality Improvement Reporting Excellence (SQUIRE) method of reporting for this project.
  
  
  RESULTS
  The UE rate decreased from 1.47 per 100 intubation days to 1.17 per 100 intubation days following the introduction of NeoBar (p=0.91). The UE rate was consistently below/at the mean, showing a stable change following the introduction of NeoBar, despite no statistically significant difference in UE rate. The common factors associated with UE were retaping/adjustment of endotracheal tube, infant agitation and performance of other procedures in both time periods.
  
  
  CONCLUSIONS
  Use of NeoBar as endotracheal tube securing device was associated with similar UE rates compared to taping method. Large prospective studies are required to assess whether NeoBar reduces the UE rate.
authors.affiliation: Section of Neonatology, Department of Pediatrics, Foothills Medical Center, University of Calgary, Room C211, 1403 29 Street NW, Calgary, AB, T2N 2T9, Canada. prakashmdped@gmail.com.
authors.forename: Prakash
authors.initials: P
authors.lastname: K Loganathan
authors.affiliation: Section of Neonatology, Department of Pediatrics, Foothills Medical Center, University of Calgary, Room C211, 1403 29 Street NW, Calgary, AB, T2N 2T9, Canada.
authors.forename: Vrinda
authors.initials: V
authors.lastname: Nair
authors.affiliation: Section of Neonatology, Department of Pediatrics, Foothills Medical Center, University of Calgary, Room C211, 1403 29 Street NW, Calgary, AB, T2N 2T9, Canada.
authors.forename: Mike
authors.initials: M
authors.lastname: Vine
authors.affiliation: Section of Neonatology, Department of Pediatrics, Foothills Medical Center, University of Calgary, Room C211, 1403 29 Street NW, Calgary, AB, T2N 2T9, Canada.
authors.forename: Linda
authors.initials: L
authors.lastname: Kostecky
authors.affiliation: Section of Neonatology, Department of Pediatrics, Foothills Medical Center, University of Calgary, Room C211, 1403 29 Street NW, Calgary, AB, T2N 2T9, Canada.
authors.forename: Derek
authors.initials: D
authors.lastname: Kowal
authors.affiliation: Section of Neonatology, Department of Pediatrics, Foothills Medical Center, University of Calgary, Room C211, 1403 29 Street NW, Calgary, AB, T2N 2T9, Canada.|Alberta Children's Hospital Research Institute for Child and Maternal Health, Calgary, Canada.
authors.forename: Amuchou
authors.initials: A
authors.lastname: Soraisham
mesh_terms: D060666:Airway Extubation / Q000706:statistics & numerical data*; D002170:Canada; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D058996:Quality Improvement
keywords: Endotracheal tube; NeoBar; Neonates; Unplanned extubation