Reducing Accidental External Ventricular Drain Dislodgement Through a Neurocritical Care Safety Bundle

Abstract

Accidental external ventricular drain (EVD) dislodgement is a preventable device-related event in neurosurgical intensive care. We have evaluated whether the implementation of a pragmatic neurocritical care safety bundle was associated with reduced accidental EVD dislodgement in an intensive care unit.

The quality improvement initiative was conducted in the Intensive Care Unit of a participating hospital in Belém, state of Pará, Brazil. A safety bundle was implemented in March 2025 after a 3-month preimplementation period. The intervention included 6 standard operating procedures, bedside checklists, 2 educational videos, and structured multidisciplinary training of 50 professionals. The primary outcome was accidental EVD dislodgement. The EVD-days were not available; the rates were expressed per 100 EVD patients.

Before implementation, 10 patients had EVDs, and 5 accidental dislodgement events were formally reported, corresponding to 50.0 events per 100 EVD patients. After implementation, 40 patients had EVDs, and 3 accidental dislodgement events were recorded, corresponding to 7.5 events per 100 EVD patients. The absolute reduction was of 42.5 percentage points and the approximate relative reduction was of 85%.

Implementation of a multidisciplinary neurocritical care safety bundle was associated with a marked reduction in accidental EVD dislodgement. This low-cost model may support EVD safety improvement in neurosurgical intensive care settings.