Investigation And Analysis Of Unplanned Extubation Risk In Pediatric Intensive Care Unit And Construction Of Its Risk Assessment Instrument

ObjectiveTo provide reference for nurses to prevent the occurrence of unplanned extubation,we investigated the risk factors of unplanned extubationand constructed an instrument to assess the risk of unplanned extubation in Pediatric Intensive Care Unit(PICU).MethodsThis was a retrospective study.A self-made questionnaire was used to collect data from PICU of the Tertiary Hospital in Qingdao(exclusive of neonatal unit)from June to December in 2016.Based on the results from semi-structured interview and retrospective analysis,the risk assessment questionnaire was made.Two rounds of inquiry from 24 clinical nurse experts from six Tertiary Hospital in China were conducted using Delphi method.Then,the risk assessment index of unplanned extubation in PICU was determined,the risk of each index was assigned and the index weight of the expert importance was calculated,based these indexs,the risk assessment instrument applying to assess the risk of unplanned extubation in PICU was established.ResultsWe examined 221 children with indwelling catheters,including 25 unplanned extubation cases.The incidence of unplanned extubation was 11.31%and 1.47 times/100days.The rate of tube reset was 60%.Logistic regression analysis showed that nurses awareness of the risk of unplanned extubation(c~2=146.733,P=0.000)is related to the incidence of unplanned extubation,and the frequency of medical proof fabric replacement(c~2=28.199,P=0.000)is related to the incidence of unplanned extubation.Therefore,nurses awareness of the risk of unplanned extubation and the frequency of medical proof fabric replacement were risk factors of unplanned extubation in PICU.The Delphi results showed that there were 24 experts participated in the first round.The positive coefficient of the experts was 100%,the authority coefficient was 0.9,the coordination coefficient was 0.206.All the24 experts participated in second round.The positive coefficient was 100%,the authority coefficient was 0.89,and the coordination coefficient was 0.307.After two rounds of expert consultation,the evaluation index of unplanned extubation risk in PICU was established,including 4 primary indicators and 16secondary indicators.ConclusionMore attention needed to be paid to the high rate of unplanned extubation in PICU.The risk factors of unplanned extubation in PICU were the awareness of the risk of unplanned extubation and the frequency of the medical proof fabric repalcement.The risk of unplanned extubation could be reduced by unplanned extubation risk management training,standardizing the flow of catheter fixation and increasing the frequency of the medical proof fabric replacement.The risk assessment index of unplanned extubation in PICU included 4 primary indicators and 16 secondary indicators.The 4 primary indicators were consciousness and state of emotion,comfort,skin conditions around indwelling catheters,coordination degree.