The Risk Assessment Scale For Unplanned Extubation Of Tracheal Intubation In ICU Adults Was Constructed Based On HFMEA Model And Its Application

Objective:ICU Adult tracheal intubation unplanned extubation Risk Assessment Scale was established to help clinical medical staff identify high-risk patients with tracheal intubation unplanned extubation,so as to reduce the incidence of trachealintubationunplannedextubation.Methods:1.Preliminaryconstructionof ICUadulttrachealintubationunplannedextubationriskassessmentscaleBased on the theory of HFMEA,through literature review,clinical data analysis,HFMEA team member screening and decision tree analysis,clinical pre-investigation,19 clinical nursing experts in the field of acute critical care were conducted 2 rounds of scale correspondence consultation by Delphi expert letter consultation method,and the entry pool was further optimized according to expert opinions and suggestions.Finally,the preliminary table of ICUAdult Risk Assessment Scaleforunplannedtrachealintubationextubationwasformed.2.Determination of the risk assessment scale for unplanned extubation of tracheal intubation in ICU adults and testofreliability,validityandpredictivevalidityA prospective study of 526 ICU patients admitted to 6 intensive care units of a Grade-III hospital in Jiangxi Province from February to October 2022 was conducted using convenience sampling and the initial version of Risk Assessment Scaleforunplannedextubationoftrachealintubation foradults.Results:1.Formation of initial entry pool of ICU adult tracheal intubation unplanned extubation risk assessment scaleThrough literature search,research methods based on HFMEA theory and brainstorming,combined with clinical practice and reference to other relevant risk assessment tools,15 first-level indicators and45 second-level indicators were preliminatively determined toform the scale item pool.2.Screening of scale itemsThe effective recoveries of the two rounds of Delphi expert correspondence questionnaires were95%(20/21)and 95%(19/20),respectively.In the first round,9 experts put forward opinions and suggestions,and in the second round,6 experts put forward written suggestions.Kendall coordination coefficient(W)was 0.432 and 0.185,respectively.The expert authority coefficients were 0.930 and0.919 respectively.After two rounds of expert letter consultation,one first-level indicator was deleted and 16 second-level indicators were modified after discussion by HFMEA group.Initially,13first-levelindicators and 41 second-level indicators wereretained.3.Definition of scale diagnostic critical valueThe area AUC under ROC curve was 0.958,P<0.01,indicating that the scale had good predictive validity.When the highest value of Yoden index is YI=0.784,the sensitivity is 100%,the specificity is 78.4%,and the critical value ofthe scale is finally determined as 17 points.4.Reliability and validity test of ICU adult tracheal intubation unplanned extubation risk assessment scale4.1Reliability testKronbachαcoefficient was 0.745,and Spearman correlation coefficient was 0.936(P<0.001),I-CVI of this scale ranges from 0.8-1.0,and S-CVI is 0.91,which proves that experts have a high degree of coordination and good consistency,and it can be considered that the content validity of each itemof this scale is good.4.2Validity testThe results of exploratory factor analysis showed that KMO=0.666>0.6,X~2=1191.556,df=78,P=0.000<0.01 of the sample,indicating that the data met the conditions for factor analysis,and there were four common factors with eigenvalue greater than 1 in the extraction scale,and the cumulative contribution rate reached 53.23%.More than 85%of the entries have a maximum load factor greater than 0.4.The results of confirmatory factor analysis showed that X~2/DF=1.528,P=0.005,GFI=0.924,AGFI=0.913,TLI=0.927,IFI=0.924,CFI=0.943 model had a good fit,and all the values exceeded the fittingindex,indicating that the structural validity ofthe scale was good.Conclusion:Inthis study,the items of"ICUAdult Tracheal intubation unplanned extubation Risk Assessment Scale"constructed based on HEMEAtheory were simplified and reasonable,withgood reliability,validity,sensitivity andspecificity,and theprediction efficiency was basically consistent with the results of clinical unplanned extubation of tracheal intubation,which could be used as a preliminary screening tool for therisk of unplanned extubation oftracheal intubation inclinical ICUadult patients.