Extubation Checklist – A Quality Improvement Project in Critical Care

Background: Extubation in critically ill patients is a high-risk process requiring coordinated multidisciplinary assessment. Extubation failure remains common and is associated with increased morbidity, mortality, and longer length of stay. Standardisation using checklists can improve both patient outcomes and staff confidence.
Aim: To increase staff confidence in performing extubation by 25% over nine months through the development and implementation of a standardised extubation checklist in a critical care department, and to improve compliance with the checklist.
Methods: This single-center quality improvement project was conducted in a Department of Critical Care over nine months. An extubation checklist was developed following a literature review and stakeholder consultation, then implemented using a multimodal strategy. Staff confidence was assessed using a locally developed questionnaire at baseline, midpoint, and project completion. Extubation checklist compliance was audited monthly. The number of failed extubations, total ventilator days, and the length of stay were measured.
Results: A reduction in failed extubation rates was observed following implementation of the checklist. Staff confidence increased by 41%, surpassing the predefined target. Checklist compliance exceeded 70% towards the end of the project. 
Conclusions: Introduction and implementation of a standardised extubation checklist supported by education and staff engagement strategies was associated with improved staff confidence. Checklists represent a practical strategy to standardise care, support clinical decision-making, and enhance patient safety in critical care settings.