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.”
Based 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.