Impact of team building using a novel technique (planned experimentation) to standardize endotracheal tube taping practice in the NICU

Abstract

Objectives: Convincing staff to standardize aspects of neonatal care is often difficult in the absence of strong evidence. A hospital-endorsed procedure for taping endotracheal tubes securely to a patient's face lacked such evidence and as a result, many nurses in the neonatal intensive care unit continued to tape their own way. Multiple attempts to standardize this practice were unsuccessful. This report discusses how a staff centric team building management strategy combined with a planned experimentation exercise was able to raise compliance to 100%. Methods:A multidisciplinary team engaged staff in a planned experimentation exercise to rapidly study how endotracheal tubes are taped securely to an infant patient's face. The exercise helped the team build trust between management and frontline staff. The exercise was a three month factorial study designed to identify a superior taping method among those already in practice. "Time to retaping" was the primary outcome that estimated how secure an endotracheal tube was. At the beginning of the study, the team acquired full staff commitment to standardize practice to whichever method the study favored, but if neither were better, staff agreed to follow the hospital endorsed method.Results: While a better method to secure endotracheal tubes was not identified, the hospital method of taping endotracheal tubes to an infant patient's face was implemented into practice successfully. Conclusion:By establishing a clear commitment from staff to standardize based on results from the planned experimenttation, the team was able to standardize endotracheal tube securement even while failing to define best practice.

Orchestrated Testing

“…Factorial design has been used successfully within the health care system to assess factors that affect clinical decisions and patient safety. 6 -10 Orchestrated testing (OT) is the application of planned experimentation using factorial design across multiple sites (within or across institutions). 11(pp25-40) OT provides the framework to study the impact of variation in practices.…”