[논문]비계획적 발관 예방을 위한 교육프로그램 적용효과

강경자; 유미

doi:10.14400/jdc.2014.12.3.331

[국내논문] 비계획적 발관 예방을 위한 교육프로그램 적용효과
Study on an Unplanned Extubation Prevention Program (UEPP) for Intubated Patients in Intensive Care Unit 원문보기

디지털융복합연구 = Journal of digital convergence, v.12 no.3, 2014년, pp.331 - 338

초록
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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.

Abstract ▼ AI-Helper

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.

주제어

AI 본문요약
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문제 정의

The program for ICU staff includes the importance of monitoring [8, 10], analysis of factors that influence UE [18], and practice hours on a restraint usage education program [14]. The change in the UE rate from the implementation of prevention program was investigated in this study. The UE rate was investigated during the preliminary investigation period from May 1, 2008 to April 30, 2009 and during the implementation of the prevention program from May 1, 2009 to April 30, 2010 with the intubated patients hospitalized in an ICU in the internal medicine department of a university hospital located in K Province, Korea.
The purpose of this study was to review a previous UE prevention program, and to develop and apply a new program to intubated patients hospitalized in ICU. Through the experience of applying the program to the actual ICU site, the features of the patients and nurses before and after UE were analyzed, and the effect of the prevention program on the UE rate was investigated.
Therefore, in this study, we analyzed various UE-causing factors and developed and discussed an integrated UE prevention program for ICU nurses by investigating the environmental features of the ICU including the patients, and verified the applicability of the prevention program in an actual ICU, in order to help ICU nurses to carry out their nursing work.

제안 방법

In addition, the program represents to apply an actionable protocol in terms of drawing fast action toward changes in patients’ conditions and cooperation across various relevant medical service teams.
In order to analyze the performance of our program in reducing the rate of UE, inpatient bed turnover rate, number of patients using ventilator, severity of illness and number of new nurses were compared in the periods before and after introduction of the program.
Prior to developing program, we reviewed previous studies and the related literatures as well as institutional reports within the previous three years, analyzed the results, and then developed the intervention contents of UE prevention program (UEPP). UEPP was developed based upon references to advanced research [8, 17], a UE prevention protocol developed by Song et al [16], and consultations with ICU expert who have worked in the field for more than 10 years.
T-test, chi-square test, and Fisher's Exact test were done to analyze the data.
In addition, because most of the patients hospitalized in the MICU have lucid consciousness, explanation and education about the emotional support and behavior of the patients, which were already discussed in previous studies [11], were considered to be important in the prevention program with regard to tube fixation and the restraints. The core part of the program was the periodic monitoring and feedback system, which were not provided through in a previous intervention study [16], enabling new nurses to approach a patient after receiving education and doing practice on UE prevention with a consistent protocol, even if the nurses may be frequently substituted.
UE measurement tool is the Unplanned Extubation Report Form first developed by Richmond et al [17] which was corrected and complemented according to the on-site ICU circumstances and used to manage the performance index of internal medicine ICU quality management. The report form was completed after it was reviewed by two nurses and one chief nurse who had a career working in ICUs for more than ten years.

대상 데이터

The change in the UE rate from the implementation of prevention program was investigated in this study. The UE rate was investigated during the preliminary investigation period from May 1, 2008 to April 30, 2009 and during the implementation of the prevention program from May 1, 2009 to April 30, 2010 with the intubated patients hospitalized in an ICU in the internal medicine department of a university hospital located in K Province, Korea. The features of the patients and the nurses who experienced UE during the two periods were also investigated.
The subjects of this study were 330 patients who underwent intubation during the preliminary investigation period and 332 patients who underwent intubation during the implementation of the prevention program among patients. The subjects also included 29 patients and 23 patients who underwent UE during the preliminary investigation period and during the implementation of UEPP, respectively, and the nurses who were in charge of UE. After giving information about the purpose of study, voluntary participation, data were obtained from all participants who agreed to engage in the study.
The subjects of this study were 330 patients who underwent intubation during the preliminary investigation period and 332 patients who underwent intubation during the implementation of the prevention program among patients. The subjects also included 29 patients and 23 patients who underwent UE during the preliminary investigation period and during the implementation of UEPP, respectively, and the nurses who were in charge of UE.

데이터처리

The UE rate before and after the implementation of the prevention UE prevention program was presented as real numbers and percentages. A one sample t-test was performed to analyze the data for the UE rate.

후속연구

Therefore, the result that the mean UE rate was significantly reduced despite the frequent changes in inexperienced ICU nurses indicated that the prevention activity through the prevention program was effective. The results of this study provide a prevention program that could contribute to the safety of patients by actively preventing UE in intubated patients hospitalized in the ICU.

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