The effectiveness of patients care development system on incident of unplanned extubation in surgery intensive care unit , Loei hospital.

Abstract

This operational research aimed to developed patients care system for preventing of unplanned extubation (UE) in Surgery Intensive Care Unit, Loei hospital. The participants were 16 registered nurses and 154 patients with respirators.  The study had been conducted from May – September 2018. The research methodology was conducted in two cycle of research operational procedures with four steps (Kemmis & McTagart, 1998) as followings: 1) developing the planning, the researcher did the plan that developing by nursing term. 2) Acting the procedure 3) observation of action outcomes 4) reflection. Data were analyzed using content analysis and percentage for statistic evaluation.

Intensive care unit in Loei hospital provided services for all type of critically ill patients. The incidence of UE in 2015 - 2017 was found as 18.25, 20.88 and 21.18 respectively. To prevent UE, patients restrain was implemented; however, the incidence of UE had still occur because of inappropriate restrain method, equipment, and monitoring process. For these reasons mentioned above, the development of care system to prevent UE was implemented. The process included. 1) human resources development including knowledge providing, enhancing competency for UE prevention. 2) development of job assignment system, mentoring new nurses system, 3) UE round system before and after nursing  shift  report, after medical procedures, and after turning positions, 4) implementation of clinical practice guideline to prevent UE in the setting 5) development of communication system and UE recoding, and    6) preparing of equipment system for restrain patients. The results of the care system development revealed that the incident of UE was reported 9.7% in June and decreased to 3.7% in September, 2018. In addition, nurses had adherence to clinical practice guideline as 89.5% 

In summary, development of care system to prevent UE  compose of  human resources development, development of  job  assignment system, UE round system, implementing a clinical practice guideline for prevent UE, development of communication system and UE recoding, and preparing of equipment system for restrain patients. After implementation of clinical practice guideline, the incidence of UE tends to decrease and it is required for continuous quality improvement for prevent UE.