Nursing-led airway clinic and patient safety: a quality study

Margarita Ramírez-López, Clínica de Enfermería de Vía Aérea Artificial, Instituto Nacional de Enfermedades Respiratorias, Secretaría de Salud, Ciudad de México, México
Marisol Malvaez-Castillo, Coordinación de Investigación en Enfermería, Instituto Nacional de Enfermedades Respiratorias, Secretaría de Salud, Ciudad de México, México
Alicia Avelino-Castillo, Clínica de Enfermería de Vía Aérea Artificial, Instituto Nacional de Enfermedades Respiratorias, Secretaría de Salud, Ciudad de México, México
Iris Y. Santiago-Pérez, Departamento de Enfermería, Escuela de Enfermería Aurelia Saldivar, Instituto Nacional de Enfermedades Respiratorias, Secretaría de Salud, Ciudad de México, México
Cecilia Benjamín-Contreras, Clínica de Enfermería de Vía Aérea Artificial, Instituto Nacional de Enfermedades Respiratorias, Secretaría de Salud, Ciudad de México, México
Dulce E. Macedonio-Agustín, Clínica de Enfermería de Vía Aérea Artificial, Instituto Nacional de Enfermedades Respiratorias, Secretaría de Salud, Ciudad de México, México

Introduction: Artificial airway management is a complex clinical process in the care of hospitalized patients. Variability in care practices increases the risk of device-related adverse events and may compromise patient safety. Objective: To describe the implementation of a nurse-led artificial airway clinic and assess its impact on patient safety. The secondary objective was to describe adherence to the ventilator-associated pneumonia prevention bundle. Method: A quality improvement project using a pre-post design without a control group was conducted at a tertiary respiratory care hospital. Three stages were established: baseline assessment (January-June 2024), implementation (July-December 2024), and model consolidation (January-December 2025). The intervention included systematic bedside assessments, continuing education, real-time feedback, and plan-do-study-act cycles. Results: During 2025, 1854 patients with artificial airways were assessed. When the baseline and implementation periods of 2024 were compared, bundle compliance among patients with an orotracheal tube increased from 62.1% to 76.0% (p < 0.001), while device-related injuries decreased from 63.1% to 31.5% (p < 0.001). Among patients with a tracheostomy, bundle compliance increased from 25.9% to 40.3% (p < 0.001). Oral hygiene and oral suctioning showed the greatest variability. Conclusions: The implementation of a nurse-led artificial airway clinic was associated with improvements in several process and safety indicators, supporting its potential as a strategy to strengthen care standardization and patient safety.

Keywords: Advanced nursing practice. Artificial airway. Quality improvement. Patient safety. Orotracheal intubation. Tracheostomy.