Case-control Study on Risk Factors of Unplanned Extubation Based on Patient Safety Model in Critically Ill Patients with Mechanical Ventilation

PURPOSE: This study aimed to identify risk factors of unplanned extubation in intensive care unit (ICU) patients with mechanical ventilation using a patient safety model. METHODS: This study was designed to be a case-control study. Data collection sheets, including 29 risk factors of unplanned extubation in mechanically ventilation patients were retrospectively collected based on a patient safety model over 3 years. From 41,207 mechanically ventilated patients, 230 patients were identified to have unplanned extubation during their ICU stay. Based on the characteristics of the cohort of 230 patients who had unplanned extubation, 460 case control comparison groups with planned extubation were selected by matching age, gender and diagnosis. RESULTS: Risk factors of unplanned extubation were categorized as people, technologies, tasks, environmental factors and organizational factors, by five components of the patient safety model. The results showed the risk factors of unplanned extubation as admission route [odds ratio (OR) = 1.8], GlasgowComa Scaleemotor (OR = 1.3), Acute Physiology and Chronic Health Evaluation score (OR = 1.06), agitation (OR = 9.0), delirium(OR = 11.6), mode of mechanical ventilation (OR = 3.0–4.1) and night shifts (OR = 6.0). The significant differences were found between the unplanned and the planned extubation groups on the number of reintubation (4.3% vs. 79.6%, p < .001), ICU outcome at the time of discharge (χ² = 50.7, p < .001), and length of stay in the ICU (27.0 ± 33.0 vs. 43.8 ± 43.5) after unplanned extubation. CONCLUSIONS: ICU nurses should be able to recognize the risk factors of unplanned extubation related with the components of the safety model so as to improve patient safety by minimizing the risk for unplanned extubation.

The Effects of Simulation Training for New Graduate Critical Care Nurses on Knowledge, Self-efficacy, and Performance Ability of Emergency Situations at Intensive Care Unit / 성인간호학회지

PURPOSE: The purpose of this study was to examine if simulation training affects new graduate critical care nurses' knowledge, self-efficacy, and performance ability in emergency situations. METHODS: Forty new graduate critical care nurses were randomly assigned to either an experimental or a control group. The experimental group had didactic with simulation. The control group received only didactic without simulation about emergency situations. The data were collected before and after the training interventions. An independent t-test used for difference among variables. RESULTS: There were no significant demographic differences between the two groups or any differences on data collected knowledge, self-efficacy and performance ability. Following the training, there were significant performance ability scores (p<.001) among the nurses receiving didactic with simulation. There were no significant difference between the two groups relative to knowledge scores (p=.117), or the self-efficacy scores (p=.100). CONCLUSION: This study showed that simulation training for new graduate critical care nurses is useful to improve performance ability on emergency situations. Hence, providing simulation training to critical care nurses during an orientation period would improve quality of critical care nursing and help the new graduates nurse's adaptation.