Quality Improvement Study on New Endotracheal Tube Securing Device (Neobar) in Neonates

Objectives 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.