以质量求发展,以服务铸品牌

Journal of Nursing ›› 2022, Vol. 29 ›› Issue (1): 7-12.doi: 10.16460/j.issn1008-9969.2022.01.007

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Development of Quality Evaluation System for Risk Management of Unplanned Extubation of Inpatients Based on 3D Quality Evaluation Model

ZHU Hong1a, LIU Zheng1a, WANG Ya1a, ZHANG Meng1b, SONG Jin-ping2   

  1. 1a. Dept. of Nursing Administration; 1b. Geriatric Center, West China School of Nursing, Sichuang University/West China Hospital of Sichuan University, Chengdu 610041, China;
    2. Meishan Hospital of West China Hospital of Sichuan University, Meishan 620010, China
  • Received:2021-08-20 Online:2022-01-10 Published:2022-02-14

Abstract: Objective To develop a quality evaluation system for the risk management of unplanned extubation of inpatients, and provide reference for quality evaluation of unplanned extubation care. Methods Based on the “structure-process-result” theory, through literature review and expert group discussion by using Delph method, a quality evaluation system for unplanned extubation risk management was developed. Results The effective recovery rates of the two rounds of expert consultation were 100% and 88% respectively; the authority coefficient Cr value 0.821,0.807 respectively,and the coordination coefficient 0.278 and 0.339, respectively. The difference was statistically significant (P<0.01). The quality evaluation index system consisted of 3 first-level, 10 second-level, and 31 third-level indicators. Conclusion The developed quality evaluation system for the risk management of unplanned extubation of inpatients is scientific, and practical, which can provide Objective basis for clinical nursing and management of unplanned extubation.

Key words: unplanned extubation, risk management, evaluation index, hospitalized patient

CLC Number: 

  • R473.6
[1] 幺莉. 护理敏感质量指标实用手册(2016版)[M]. 北京:人民卫生出版社,2016.
[2] Kiekkas P, Aretha D, Panteli E,et al.Unplanned Extubation in Critically Ill Adults: Clinical Review[J]. Nurs Crit Care, 2013, 18(3):123-134.DOI:10.1111/j.1478-5153.2012.00542.x.
[3] 温春华,钟品悦,王丽蓉. 200例护理不良事件调查分析[J].护理实践与研究,2017,14(12):119-121. DOI:10.3969/j.issn.1672-9676.2017.12.055.
[4] 史瑞芬,刘银燕,张振路.广东省110家三级医院护理不良事件监测及报告现状[J].中国护理管理,2015,15(9):1098-1110. DOI:10.3969/j.issn.1672-1756.2015.09.023.
[5] Kwon E, Choi K.Case-control Study on Risk Factors of Unplanned Extubation Based on Patient Safety Model in Critically Ill Patients with Mechanical Ventilation[J]. Asian Nurs Res,2017,11(1):74-78. DOI:10.1016/j.anr.2017.03.004.
[6] Lucchini A, Bambi S, Galazzi A,et al.Unplanned Extubations in General Intensive Care Unit: A Nine-year Retrospective Analysis[J]. Acta Biomed,2018,89(7-S):25-31.DOI: 10.23750/abm.v89i7-S.7815.
[7] Cosentino C, Fama M, Foà C, et al.Unplanned Extubations in Intensive Care Unit: Evidences for Risk Factors: A Literature Review[J]. Acta Biomed,2017,88(5S):55-65.DOI:10.23750/abm.v88i5-S.6869.
[8] Matteo D, Simona C, Alvisa P.Unplanned Extubations in an Intensive Care Unit: Findings from a Critical Incident Technique[J]. Intensive Crit Care Nurs,2018,47:69-77.DOI:10.1016/j.iccn.2018.04.012.
[9] 刘其兰,江智霞,黎张双子,等. ROC曲线对ICU患者非计划性拔管高危临界值的预测分析[J].中国卫生统计, 2019, 36(2):243-245.
[10] 韩银风. 集束化护理对降低ICU非计划性拔管率的效果[J]. 护理实践与研究,2017,14(17):130-131. DOI:10.3969/j.issn.1672-9676.2017.17.055.
[11] Lee AL, Chung CR, Yang JH, et al.Factors Affecting Invasive Management after Unplanned Extubation in an Intensive Care Unit[J]. Acute and Critical Care, 2015, 30(3):164-170. DOI:10.4266/kjccm.2015.30.3.164.
[12] Lin PH, Chen CF, Chiu HW, et al.Outcomes of Unplanned Extubation in Ordinary Ward Are Similar to Those in Intensive Care Unit: A STROBE-compliant Case-control Study[J]. Medicine (Baltimore). 2019, 98(11):e14841. DOI: 10.1097/MD.0000000000014841.
[13] 钟梅. 管道滑脱危险因素评估及护理措施落实单在神经内科卒中单元住院病人中的应用[J].中华现代护理杂志,2013,19(1):96-97.DOI:10.3760/cma.j.issn.1674-2907.2013.01.036.
[14] Gao F, Yang LH, He HR, et al.The Effect of Reintubation on Ventilator-associated Pneumonia and Mortality Among Mechanically Ventilated Patients with Intubation:A Systematic Review and Meta-analysis[J]. Hear Lung,2016,45(4):363-71.DOI:10.1016/j.hrtlng.2016.04.006.
[15] 张晓静,张会芝,周玉洁,等. 住院患者非计划性拔管风险评估体系的建立[J]. 中华护理杂志,2015,50(11):1331-1334.
[16] Song YG, Yun EK.Model for Unplanned Self-extubation of ICU Patients Using System Dynamics Approach[J].J Korean Acad Nurs,2015,45(2):280-292.DOI:10.4040/jkan.2015.45.2.280.
[17] 黄素素,陈香萍,罗维嘉,等. 成年气管插管患者非计划性拔管风险评价指标体系的构建[J]. 护理与康复,2020,19(3):1-5. DOI:10.3969/j.issn.1671-9875.2020.03.001.
[18] Donabedian A, Wheeler JR, Wyszewianski L. Quality, Cost,Health: An Integrative Model[J]. Med Care,1982, 20(10):975-992. DOI:10.1097/00005650-198210000-00001.
[19] 刘兴红,李素云,喻姣花,等. 医院内静脉血栓栓塞护理质量评价指标体系的构建[J]. 护理学报, 2019, 26(21):21-25. DOI:10.16460/j.issn1008-9969.2019.21.021.
[20] 孙慧慧,陈淑琴,王小焕,等. 基于三维质量结构模式普外科加速康复护理质量评价指标体系的构建[J].护理学报, 2019, 26(23):29-33. DOI:10.16460/j.issn1008-9969.2019.23.029.
[21] 李梦婷,李国宏.护理质量评价体系的研究进展[J].中国护理管理,2015,15(2):212-214. DOI:10.3969/j.issn.1672-1756.2015.02.027.
[22] 张晓静,李真,曹静,等.卧床患者常见并发症的护理管理现状[J].中国护理管理杂志,2016,16,(4):433-437. DOI:10.3969/j.issn.1672-1756.2016.04.001.
[23] 李玉梅,黄瑛,张贵芬,等.基于精细化管理理念制作岗位核查清单实施护理质量过程控制的效果[J].护理管理杂志,2016,16(12):886-888.DOI:10.3969/j.issn.1671-315X.2016.12.020.
[24] 陈煌,邓小玲,李秋燕,等.住院病人非计划性拔管风险评估体系的构建[J]. 护理研究,2019,33(14):2404-2409. DOI:10.12102/j.issn.1009-6493.2019.14.008.
[25] Fitzgerald RK, Davis AT, Hanson SJ.Multicenter Analysis of the Factors Associated with Unplanned Extubation in the PICU[J]. Pediatr Crit Care Med, 2015, 16(7):e217-23.DOI: 10.1097/PCC.0000000000000496.
[26] 国家卫生健康委员会办公厅. 护理专业医疗质量控制指标(2020年版)[EB/OL].(2020-08-04) [2021-04-26]. http://www.nhc.gov.cn/yzygj/s7657/202008/c39639a79f7d4a6b935f33f87c57e2dc.shtml.
[27] 李智英,成守珍,吕林华,等.护理质量敏感指标在优质护理评价及持续改进中的应用[J].中华护理杂志,2014,49(10):1168-1171. DOI:10.3761/j.issn.0254-1769.2014.10.002.
[28] 黄天雯,肖萍,陈晓玲,等.骨科护理质量敏感指标的构建[J].中华护理杂志,2018,53(8):945-949.DOI:10.3761/j.issn.0254-1769.2018.08.009.
[29] 么莉. 护理敏感质量指标监测基本数据集实施指南(2018版)[M]. 北京:人民卫生出版社,2018:82-145.
[30] 蒋文春,温贤秀,顾凤娇.应用德尔菲法和层次分析法构建血液透析室护理管理质量评价标准体系[J]. 护理学报,2018,25(18):16-21.DOI:10.16460/j.issn1008-9969.2018.18.016.
[31] 刘丽华,邓小玲,陈小叶,等.非计划性拔管流行特征与危险因素分析[J].解放军护理杂志,2016,33(17):14-19. DOI:10.3969/j.issn.1008-9993.2016.17.004.
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