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The PEST Model

A Quality Improvement Project to Reduce Self-extubation in the Intensive Care Unit

Lin, Yongxing Patrick BSc (Nursing) (Hons), RN; Wu, Man BN, RN, CCRN

Dimensions of Critical Care Nursing: July/August 2019 - Volume 38 - Issue 4 - p 221–227
doi: 10.1097/DCC.0000000000000364
Leadership DIMENSION

Background Self-extubation is an adverse patient event that can lead to severe complications. Gaps in clinical practice from the lack of nursing awareness and decision making capacity have often resulted in cases of preventable self-extubation. Review of current evidence suggests that initiatives to support nursing clinical decision making can help prevent adverse patient events such as self-extubation.

Aims The aim of this study was to reduce the incidence of self-extubation by 50% in a cardiology intensive care unit over 1 year.

Methods A quality improvement project was undertaken with a PEST model of nursing care introduced from January 2017 to December 2017 in the cardiology intensive care unit to guide nursing staff to assess and render appropriate interventions along patient domains such as pain, endotracheal tube securement, sedation, and tie to prevent incidences of self-extubation.

Results Incidences of self-extubation have reduced to 5 cases in 2017, reflecting a 50% improvement from 10 cases in 2016.

Conclusions Formalizing practice standards into an easy-to-remember mnemonics or framework can improve patient outcomes. Policy makers must be aware that initiatives to facilitate decision making can improve patient safety.

Yongxing Patrick Lin, BSc (Nursing) (Hons), RN, is a senior staff nurse at the Department of Nursing Service, Tan Tock Seng Hospital, Singapore.

Man Wu, BN, RN, CCRN, is a nurse clinician at the Department of Nursing Service, Tan Tock Seng Hospital, Singapore.

The authors have disclosed that they have no significant relationship with, or financial interest in, any commercial companies pertaining to this article.

Address correspondence and reprint requests to: Yongxing Patrick Lin, BSc (Nursing) (Hons), RN, 11 Jalan, Tan Tock Seng, Singapore 308433 (

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