C36-13 Implementation of a Standardized Pre-intubation Checklist in the Medical Intensive Care Unit

Abstract Rationale Endotracheal intubation is high-risk, particularly in the medical intensive care unit (MICU) where many patients are hemodynamically unstable with multiple comorbidities. At our institution, there was no standardized pre-intubation checklist, which resulted in variations in preparedness and anticipatory precautions among intubations performed in the MICU. Some studies, however, have demonstrated that interdisciplinary collaboration is associated with better patient outcomes (Ma). Local problem: The absence of a standardized pre-intubation checklist has led to inconsistent team practices and increased potential for preventable errors during endotracheal intubation. Methods Our goal was to improve MICU staff comfort level and communication by implementing a checklist. A multidisciplinary team - including nursing, pharmacy, respiratory therapy, advanced practice providers (APPs) and physicians - developed and implemented a pre-intubation checklist for use in the MICU. We collected data using pre- and post-implementation surveys assessing team members' perceptions of preparedness and communication during intubation events. MICU staff received and completed these surveys immediately prior to implementation and 60 days after. Additional metrics included rate of checklist completion documented in the intubation notes. We provided education to all staff in the MICU prior to rollout. Results The survey response breakdown by team member role was as follows: 45% nursing, 27% attendings/fellows/APPs, and 13% respiratory care. Prior to the institution of the checklist, 62% of staff perceived no standard intubation protocol. Only 39% of the staff felt supplies were consistently available at the start of endotracheal intubations in the MICU. Post-implementation, perception of an existing protocol increased from 38% to 74%. Team satisfaction with supply availability increased from 39% to 53%. Staff reported improvements in perceived opportunities to speak up and in overall effective communication. Specifically, prior to implementation, 62% of staff felt there was effective communication more than half the time during intubations. Perception of effective communication increased to 92% post-checklist roll out (Figure 1). 60 days post-implementation, EMR queries indicated that providers used the checklist in 100% MICU intubations (n = 21). Conclusion The checklist is feasible to use and supports interdisciplinary collaboration and communication. Adoption also increased staff confidence that appropriate supplies were available more consistently for endotracheal intubations. This initiative highlights the value of structured communication tools in high-risk clinical scenarios. This abstract is funded by: None