Home Internal Medicine Critical Care ICU Physician Unveils New Self-Extubation Order Set

ICU Physician Unveils New Self-Extubation Order Set

The Pannus
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ICU Physician Unveils New Self-Extubation Order Set

AUGUSTA, ME – An ICU physician in Augusta, Maine is now using a self-extubation order set.  “It is a beautiful concept, really,” gushes ICU physician and order set creator Teresa Elder.  She elaborates, “I’m a firm believer in patient autonomy.  When a patient has failed a spontaneous breathing trial after spontaneous breathing trial, sometimes you just have to let the patient decide what is best for them.”

physicianBased on the initial data provided by Dr. Elder, the vast majority of patients decide they no longer wish to have their vocal cords ravaged by a large plastic tube.  She injected a new concept into her ICU in August of 2013 and hasn’t looked back since: the self-extubation order set.

Nurses are asked to discontinue sedation, loosen physical restraints, and minimize time spent at the bedside.  At this point, most patients choose to do what any normal human would do: they defend themselves against the evil machine attacking their face with compressed air.

“It is either a slam dunk extubation or not.  For those high-risk extubations, it just makes sense,” continued Elder.  “Why accept that medical-legal liability?  Technically, the documentation reflects that I’m not making the decision to extubate at all.”

Aside from rates of reintubation soaring light years above rates traditionally considered acceptable, the order set has been a big hit.  ICU length of stay times are down, for one reason or another, not excluding death.  Patient satisfaction scores are up, and Elder hopes to see a larger electronic medical record firm distribute her order set across the U.S.

68 COMMENTS

  13. Wouldn’t do it as the RT just because I’m worried about the nurse getting blamed- it’s her patient- usually I’ll just talk directly to an attending if a resident gives me that kind of bs.

  48. WOW, a forward thinker. I will admit, about 2 decades ago. I had a patient intubated and on the vent on CPAP….He had been on it for hours and hours. I called the resident to get the patient extubated…he stated, “I have to check with the Chief!” I said, NO, he is ready to be extubated. He frantically said…I will call you back. An hour later he did not call back. So, I deflated the balloon on the ET tube and told the patient, who was completely with it, “Pull the tube out quickly and in a straight line. He did…said, Thank you. I called the resident back and told him the patient extubated himself and is on nasal cannula at 2L. The patient went home the next day.

  49. Perhaps it should be reserved for pts who have, for behavioural reasons, failed traditional weaning attempts. There should then be a clause in the orders that it’s a one way extubation. A sink or swim if you will. That would fix the reintubation rates.

  51. Easy: “q2 min ETT suctioning, chlorhexidine q15 min alternating with standard oral care, and haldol 0.005 mg q 12 hr PRN for goal rass +3 to +4.” Either the patient or the nurse will have the tube out in an hour or less

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