A Research On The Nursing Risk System Of Unplanned Extubation In Critically Ill Patients

ObjectiveAs we know, Unplanned extubation(UEX) has always being a common and high-risk nursing event in the intensive care unit(ICU). Once UEX occurs,it may lead to a variety of complications, including morbidity, mortality, so as to decease the quality of life, and a waste of medical resources, even threaten to the patient’s life. As well as the risk management mechanism in some developed countries is being perfected, the construction in our country has just entered the initial stage, weak and limited. The risk elements of UEX appear to be full of complexity and uncertainty. More and more survey having shown that strengthen risk management was fundamental way to decrease the rate of UEX, but we still don’t have a proper index system of risk management. Taken into consideration, we plan to establish a set of evaluation indicators system of risk management based on the management level which expected to help administrators change their concepts of management, specify nursing related risks, and provide available evidence for crews to formulate nursing strategies and improve nursing quality.Methods:Firstly, the research chose unplanned extubation clinical case reports derived from the ICU and specialist care units(except NICU) of a comprehensive hospital in Chongqing since January 2011 to October 2013. And then a retrospective analysis of factors for UEX was made to understand the clinical current situation.Based on the literature review and previous case analysis, we designed a questionnaire revised through clinical investigation and two round Delphi techniq ues, and then made a survey on qualified medical staffs working in ICU, CCU and Emergency Department as a cluster sampling. The reliability and validity of the questionnaire were tested by Principal Component Analysis(PCA),Factor Analysis,Pearson Correlation Analysis and Cronbach’-sα coefficient.According to the objective and research principles, combined with previous results, we build a basical framework of nursing risk management system in critical patients finally. We count the weight value by analytic hierarchyprocess(AHP) and Delphi, the former for the first grade index while the latter for other grade indexs. And finally, we conducted a consistency test.Results:After collected 22 clinical case reports, we sum up four kinds of significant risk factors, including patient-associated risk factor, nurse-associated risk factors, tube-associated risk factors and critical periods. Age, awareness and discomfort belong to the patient-associated risk factors. Improper care operation, lacking of experience, physical restraints and sedation belong to the nurse-associates risk factors. Tube fixation and method belong to tube-associated risk factors.We have distributed 20 questionnaires for a small sample investigation, one was lost, and the recovery rate was 95%. The general Cronbach’s ɑ coefficient of the original questionnaire was 0.922. 170 questionnaires were distributed in the second clinical investigation 162 questionnaires were recoveried, and exculding 2 invalid questionnaires, the effective rate was 98.8%. The general Cronbach’s coefficient of the whole questionnaire was 0.936, The KMO was 0.894, Bartlett, χ2=3219.606, sig=0.000;Exploratory factors extracted 5 common factors,cumulative as 69.041%.The content Validity Index was 0.991. The final questionnaire consists of 5 dimensions, 27 items in total.After two round Delphi techniques, we deleted two items, added one item, and renamed one. The research constructed the nursing risk management system of unplanned extubation on critical patients which included 4 primary indexes, 10 secondary indexes and 35 third-rate index.The management system verified good consistency.Conclusions:We designed a questionnaire with good reliability and validity which has a clinical value about the risk factors of UEX for critical patients by consult ing experts and clinical research, and finally summarized the risk factors of UEX for critical patients. It lay the theoretic foundation for constructing the Nursing Risk Management System.The nursing risk system of unplanned extubation on critical patie nts makes a precise choice in indicators. It combines the advantages of both Delphi and Analytic Hierarchy Process(AHP), which realizes the quantitative recognition of risk factors, and also guaranteed the scientificalness and objectivity of the weight index.