Abstract:

Objective To develop an intelligent early warning and decision support system for the prevention of unplanned endotracheal extubation (UEE) in adults,so as to prevent the occurrence of extubation events and ensure the safety of patients. Methods A system research and development team was set up to build a UEE early warning and decision support system with 3 modules,including evaluation,early warning,and decision-making. It was applied in the ICU of a tertiary A hospital in Tianjin in September 2020. The researchers compared the implementation rate of UEE preventive measures,the incidence rate of UEE,and the satisfaction of ICU nurses with the system before the application (March-August 2020) and after the application (September 2020-March 2021). Results Compared with the system before application,the implementation of UEE preventive measures by ICU nurses was significantly improved,including risk assessment,endotracheal intubation and fixation,analgesia and sedation observation,norms and constraints,and the differences are statistically significant (P<0.05). No UEE occurred before and after system application. The satisfaction score of ICU nurses on the system is (91.20±7.44) points,which is at a high level. Conclusion The UEE early warning and decision support system can assist ICU nurses to scientifically carry out UEE prevention,improve the implementation rate of UEE preventive measures,and ensure patient safety.

Key words: Oral Tracheal Intubation, Unplanned Extubation, Risk Evaluation, Warning, Clinical Decision-Making, Information Systems, Nursing Care

摘要：

目的 研发针对经口气管插管患者的气管插管非计划性拔管 (unplanned endotracheal extubation,UEE) 预警及决策支持系统,并评价其应用效果。 方法 组建研发小组,构建UEE预警及决策支持系统,包括评估、预警、决策3个模块。2020年9月在天津市某三级甲等医院ICU中应用,比较系统应用后 (2020年9月—2021年3月) 与应用前 (2020年3月—8月) UEE预防措施执行率、UEE发生率,收集ICU护士对该系统的满意度。 结果 应用UEE预警及决策支持系统后,UEE预防措施执行率有所提高,在风险评估、气管插管固定、镇痛镇静观察、规范约束方面与系统应用前比较,差异均具有统计学意义 (P<0.05) ;系统应用前后均未发生UEE;ICU护士对该系统的满意度评分为 (91.20±7.44) 分,处于较高水平。 结论 UEE预警及决策支持系统能够辅助ICU护士科学开展UEE预防,提高UEE预防措施执行率,保障患者安全。

关键词: 经口气管插管, 非计划性拔管, 风险评估, 预警, 临床决策, 信息系统, 护理