The Development Of Risk Factors For Aspiration Assessment Scale For Patients With Adult Invasive Mechanical Ventilation

Objective:Through the establishment of aspiration risk assessment scales for invasive mechanical ventilation in adult patients and the analysis of its reasonableness and applicability in preliminary clinical application, this paper aims to provide scientific and reliable evaluation tools for the clinical assessment of aspiration risk of invasive mechanical ventilation in adult patients. The results can effectively guide the clinical nursing staff to assess aspiration risk timely and accurately so that they can take corresponding prevention and control measures to reduce the incidence of aspiration, promote patient safety.Methods:(1) This study uses Delphi method to filter assessment scales entries. Objective sampling method is used to invite 17 specialists who have long been engaged in critical care in grade A tertiary hospital in Shanxi to do the questionnaires. This study filter assessment scales entries according to the collection and statistical analysis of the answers of the questionnaires.(2) By taking the convenient sampling method, this study uses the initial assessment scale of invasive mechanical ventilation in adult patients with risk factors for aspiration as a research tool. Namely, at first, this study selects 20 patients meeting the inclusion criteria to do pre-survey, then selects 115 patients meeting the inclusion criteria to do initial formal investigation. This study evaluates the suitability of the rating scale by item analysis,reliability analysis, validity analysis and feasibility analysis of its clinical application.Hierarchical analysis is used for the risk of aspiration to determine the risk level score ofaspiration, eventually the formal scale is formed.Results:.(1) Through two rounds of expert consultation, the positive coefficient was 94.44%and 100% respectively, and the expert authority coefficient was 0.848 and 0.852 respectively. In the first round, experts assigned to importance and accuracy of the entry mean ≥4.35 and full score ratio≥35.30%. In the second round, experts assigned to importance and accuracy of the entry mean ≥4.41 and full score ratio≥41.2%. In the first round, experts draw a conclusion that the importance and accuracy of entry coordination coefficient are 0.428 and 0.413; in the second round, experts draw a conclusion that the importance and accuracy of entry coordination coefficient are 0.594 and 0.561. Tested by x2, the scale is statistically significant(P <0.01).(2) The preliminary establishment of assessment scale consists of 2 dimensions, 12 items and 30 level entry forms. The internal consistency reliability Chronbach’s alpha coefficient of the scale is 0.713, the dimension is 0.688 ~ 0.725 respectively; Retest reliability Pearson correlation coefficient is 0.950, the dimension 0.936 ~ 0.938 respectively, inter-rater reliability Pearson correlation coefficient 0.947. Finally, aspiration risk is divided into mild, moderate and severe three levels according to the scale score < 17 points, 17 ~ 22 points and > 22 points.Conclusions:(1) Using the Delphi method in this study, after two rounds of expert consultation,expert positive degree and extent of authority were higher and the degree of concentration and coordination of the expert opinions are also good. Expert consultation result has high reliability. A preliminary screening scale items for the establishment adult patients with invasive mechanical ventilation aspiration risk factors assessment scale provide reliable reference.(2) The reliability, validity and feasibility of the scale are good. It can be used as an assessment tool in clinical treatment to the adult patients with invasive mechanical ventilation aspiration risk to effectively evaluate the degree of risk of aspiration.