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Study on an Unplanned Extubation Prevention Program (UEPP) for Intubated Patients in Intensive Care Unit

비계획적 발관 예방을 위한 교육프로그램 적용효과

  • Kang, Kyung-Ja (College of Nursing, Jeju National University) ;
  • Yu, Mi (Department of Nursing, Namseoul University)
  • 강경자 (제주대학교 간호학과) ;
  • 유미 (남서울대학교 간호학과)
  • Received : 2014.02.03
  • Accepted : 2014.03.20
  • Published : 2014.03.28

Abstract

Unplanned extubation prevention program (UEPP) was developed and applied to intubated patients hospitalized in a medical intensive care unit (ICU). The number of unplanned extubation was 29 during the preliminary investigation and 23 cases during the prevention intervention program. The general features of the patients and nurses who experienced UE did not have any significant differences between the two periods, with only the number of new nurses in the ICU being significantly different (p=.039). Although the number of new nursing staff in the ICU was high, the mean rate of unplanned extubation, which is the number of UE days per 1000 intubation days, was 8.8 during the prevention intervention program, which was significantly lower than 12.3, the mean rate of UE during the preliminary investigation (t=-2.333, p=.040). The results provide a prevention program that could contribute to the safety of patients by actively preventing unplanned extubation in intubated patients in ICU.

본 연구는 내과계 중환자실에 입원한 기관삽관 환자의 비계획적 발관 예방프로그램을 개발하여 비계획적 발관율을 감소시키고 간호사들이 실무에서 비계획적 발관에 적극적으로 대처할 수 있도록 도움을 주기 위해 수행되었다. 조사기간은 사전기간이 2008년 5월부터 2009년 4월이었고, 프로그램 적용기간은 2009년 5월부터 2010년 4월로 각각 1년씩이었다. 기간 내 조사 대상 총 삽관환자는 사전시기와 중재 시기에 각각 330명, 332명이었으며, 이들 중 비계획적 발관을 경험한 사전 29사례와 적용기간 23사례에 대해 발관경험 환자와 담당간호사의 발관 관련 제 특성을 추가적으로 살펴보았다. 통계분석은 SPSS 18.0을 이용하였다. 비계획적 발관을 경험한 환자와 간호사의 제 특성은 유의한 차이를 보이는 것은 없었으나 두 시기에 신규 간호사의 진입비율에 유의한 차이가 있었다(p=.039). 기관내관 삽입 1000일당 비계획적 발관율은 신규 간호사 진입이 많았음에도 적용 기간의 평균이 8.8을 보여 사전 관찰시기의 평균 발관율 12.3과 비교하여 유의하게 감소(t=-2.333, p=.040)하였으므로 본 연구의 결과는 중환자실 삽관환자의 비계획적 발관예방 활동을 통해 환자 안전에 기여할 수 있는 프로그램이라 사료된다.

Keywords

References

  1. O. D. Listello, C. N. Seessler, Unplanned extubation: Clinical predictors for reintubation. Chest, Vol. 105, No. 5, pp. 1496-1503. 1994. https://doi.org/10.1378/chest.105.5.1496
  2. M. J. Grap, C. Glass, M. O. Lindamonnd, Factors related to unplanned extubation of endotracheal tubes. Critical Care Nurse, Vol. 15, No. 2, pp. 57-65. 1995.
  3. S. H. Yeh, L. N. Lee, T. H. Ho, M. C. Chiang, L. W. Lin, Implications of nursing care in the occurrence and consequences of unplanned extubation in adult intensive care units. International Journal of Nursing Studies. Vol. 41, No. 3, pp. 255-262, 2004. https://doi.org/10.1016/S0020-7489(03)00136-6
  4. D. P. Coppolo, J. J. May, Self-extubation: A 12-month experience. Chest, Vol. 98, No. 1, pp. 165-169, 1990. https://doi.org/10.1378/chest.98.1.165
  5. J. J. Lee, K. M. Lee, Y. B. Lee, B. M. In, D. J. Um, R. Chol, Unplanned extubation and factors affecting reintubation in ICU patients. Korean Journal of Critical Care Medicine, Vol. 11, No. 2, pp. 179-183, 1996.
  6. B. N. Koo, S. O. Koh, T. D. Kwon, Predictors for reintubations after unplanned endotracheal extubation in multidisciplinary intensive care unit. Korean Journal of Critical Care Medicine, Vol. 18, No. 1, pp. 20-25, 2003.
  7. J. S. Krinsley, J. E. Barone, The drive to survive: Unplanned extubation in the ICU. Chest, Vol. 128, No. 2, pp. 560-566, 2005. https://doi.org/10.1378/chest.128.2.560
  8. U. Beckmann, D. M. Gillies, Factors associated with reintubation in intensive care; An analysis of causes and outcomes. Chest, Vol. 12, No. 2, pp. 538-542, 2001.
  9. Y. K. Choi, K. S. Kim, A study on the influencing factor of unplanned endoracheal extubation in ICUs. Quality Improvement in Health Care, Vol. 9, No. 1, pp. 74-89, 2002.
  10. K. M. Birkett, K. A. Southerland, G. D. Leslie, Reporting unplanned extubation. Intensive and Critical Care Nursing, Vol. 21, No. 2, pp. 65-75, 2005. https://doi.org/10.1016/j.iccn.2004.07.012
  11. J. S. Kim, The management of unplanned extubation prevention for intubated patients. Journal of Korean Critical Care Nursing, Vol.6, pp.1-8. 2005.
  12. E. H. Choi, H. J. Kim, M. H. Park, J. Y. Lee, The comparision of the unplanned extubation according to the method for fixing the endotracheal Tube. Journal of Korea Clinical Nursing Research, Vol. 12, No. 2, pp. 7-16, 2006.
  13. J. S. Kim, E. S. Lee, J. H. Park, Effects on unplanned extubation, oral mucosa, and facial skin integrity of new method to secure endotracheal tube. Journal of Korea Clinical Nursing Research, Vol. 15, No. 3, pp. 49-59, 2009.
  14. J. M. Yeo, M. H. Pak, Effects of on education program for nurses on the UE of restraints. Journal of Korean Academy of Nursing, Vol. 36, No. 3, pp. 532-541, 2006.
  15. Y. H. Kim, Y. S. Jeong, J. H. Park, S. H. Yoon, The effects of nurse education on physical restraint use in the ICU. Korean Journal of Anesthesiology, Vol. 55, No. 5, pp. 590-595, 2008. https://doi.org/10.4097/kjae.2008.55.5.590
  16. K. J. Song, E. O. Kwon, E. J. Jeong, H. J. Shin, O. H. Park, E. H. Shin, The effect on unplanned extubation prevention program. Journal of Korean Critical Care Nursing, Vol. 4, pp. 23-32, 2003.
  17. A. L. Richmond, D. L. Jarog, V. M. Hanson, Unplanned extubation in adult critical care. Critical Care Nurse, Vol. 24, No. 1, pp. 32-37, 2004
  18. A. R. Huizing, J. P. Hamers, M. J. Gulpers, M. P. Berger, Short-term effects of an educational intervention on physical restraint use: A cluster randomized trial. BMC Geriatrics, Vol. 6, pp. 17. 2006. https://doi.org/10.1186/1471-2318-6-17
  19. P. Kiekkas, D. Aretha, E. Panteil, G. I. Baltopoulos, K. S. Filos, Unplanned extubation in critically ill adults: Clinical review. Nursing in Critical Care, Vol. 18, No. 3, pp. 123-134, 2013. https://doi.org/10.1111/j.1478-5153.2012.00542.x
  20. P. S. da Silva, M. C. Fonseca, Unplanned endotracheal extubations in the intensive care unit: Systematic review, critical appraisal, and evidence-based recommendations. Anesthesia and Analgesia, Vol. 114, No. 5, pp. 1003-1014, 2012. https://doi.org/10.1213/ANE.0b013e31824b0296
  21. L. A. Despins, Patient safety and collaboration of the intensive care unit team. Critical Care Nurse, Vol. 29, No. 2, pp. 85-92, 2009.