Date of Doctor of Nursing Practice Project Completion
Spring 5-8-2026
Faculty Advisor
Deborah McCrea
Abstract
Purpose: To implement and evaluate a nurse-led planned extubation safety bundle designed to improve nurse preparedness, interdisciplinary communication, workflow consistency, and confidence during planned extubation events in a pediatric Cardiac Intensive Care Unit (CICU).
Background: Planned extubation in critically ill pediatric cardiac patients requires effective interdisciplinary coordination. Variability in nurse preparation, communication, and knowledge of sedation pharmacokinetics contributed to workflow inefficiencies and patient safety concerns. Evidence supports standardized nurse-led protocols to improve extubation readiness and reduce practice variability.
Methodology: A prospective pre-post quality improvement project was conducted over eight weeks in a pediatric CICU. The intervention included a nurse-led planned extubation safety bundle consisting of readiness and reintubation checklists, communication prompts, spontaneous awakening and breathing trial reminders, and a sedation half-life reference guide. Data were collected using pre-implementation (n = 48) and post-implementation (n = 52) nurse surveys, post-extubation surveys, workflow audits, and extubation timing logs.
Results: Forty-five planned extubations occurred, with a bundle utilization rate of 77.8%. Overall high-confidence responses increased by 12.7 percentage points, with the greatest improvement observed in sedation and paralytic medication knowledge (+37.9 percentage points). Nurses also reported improved communication, preparedness, workflow consistency, and interdisciplinary collaboration, while 88.6% of extubations were perceived as smooth and efficient.
Implications: The planned extubation safety bundle was feasible, low cost, and associated with improved nurse confidence, communication, and workflow standardization. The intervention demonstrates potential for long-term sustainability and adaptation to other pediatric critical care settings.
Keywords
Planned extubation, pediatric cardiac intensive care, quality improvement, nurse-led intervention
Recommended Citation
Broderick Sutton, "Implementation of a Planned Extubation Nurse-Led Safety Bundle in a Pediatric Cardiac Intensive Care Unit" (2026). Doctor of Nursing Practice Final Project Abstract. 206.
https://digitalcommons.library.tmc.edu/dnp_abstract/206
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Anesthesia and Analgesia Commons, Critical Care Nursing Commons, Equipment and Supplies Commons, Pediatric Nursing Commons, Quality Improvement Commons, Respiratory System Commons