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Accidental critical care device removals in intensive care units (ICUs) are serious preventable incidents that have major implications. The study aimed to understand possible causes of such events and identify interventions that reduced their occurrence. The researchers conducted a single-center audit by collecting patient data and bundle forms for accidental device removal across two consecutive periods; they retrospectively reviewed the data from the first period (August 1, 2019 to January 31, 2020) and prospectively analyzed the data from the bundle forms obtained in the second (February 1, 2020 to July 31, 2020). From the findings of the first period, the researchers designed an intervention comprising nurses’ adherence to a care bundle checklist and an educational campaign for the care-taking team and applied it in the second period. Patients either accidentally removed the central venous lines secondary to agitation (47%), or it happened by loss of catheter securement (21%), or during daily care (17%) or patient transfer (13%). Such inadvertent incidents resulted in reinsertion with another central venous line (69%), agitation due to sedation interruption (47%), development of hemodynamic instability because of interruption of inotrope administration (30%), significant bleeding that required intervention (21%), and no complications (39%). The overall nurses’ compliance to the care bundle checklist improved from 87% to 97% after introduction of the intervention and the number of devices found in place increased. Therefore, the designed care bundle checklist and educational program successfully decreased the accidental removal of critical care devices.

Evaluating the impact of audit interventions on accidental removal of critical care devices in the intensive care unit - Clinical Audit Project