住院患者非计划性拔管风险评估体系的建立

Establishment of risk assessment system for unplanned extubation of inpatients

目的 构建住院患者非计划性拔管风险评估体系,为提供科学有效的护理干预措施提供依据。方法 成立专家咨询小组,通过对医院近几年非计划拔管的数据分析、前期关键专家访谈与文献查证筛选指标体系,对20名临床护理专家进行2轮咨询,形成住院患者非计划拔管风险评估体系;依据体系设计住院患者非计划拔管评估表,选取4名护理人员运用评估表对医院30例非计划拔管实例进行回顾性分析,以验证体系的效果。结果 专家积极性为100%,权威程度系数为0.90,通过2轮专家咨询,形成“意识、精神、情绪状态”“舒适度”“固定方式”“有无约束”“健康宣教”5个核心指标的住院患者非计划拔管风险评估体系。该体系评定者间信度为0.712~0.856,对患者非计划性拔管的检出率为75%~91.7%。结论 应用德尔菲法构建住院患者非计划性拔管风险评估体系具有较高的科学性,对于指导临床护理工作具有重要意义。

Objective To establish the risk assessment system of unplanned extubation（UE）,and to provide basis for scientific and effective interventions. Methods Expert consulting group was set up,and indicator system was selected through analyzing unplanned extubation data in hospital in recent years,expert interviews and literature review. Two-round expert consuhation was conducted among 20 experts to establish the unplanned extubation risk assessment system. The unplanned extubation risk assessment scale was developed according to the system,and 30 cases of extubation were evaluated using this scale simultaneously by four nurses retrospectively to test the efficacy of this system. Results Expert＇s enthusiasm was 100%,authority coefficient was 0.90. After two-round consuha- tion,a risk assessment system of 5 core indictors and risk indictors was developed. The 5 core indictors included ＂consciousness, spirit, emotional status＂, ＂comfort＂, ＂fixed method＂, ＂restraint or not＂ and ＂health education＂. The inter-rater reliability was among 0.712~0.856. The detection rate of unplanned extubation was among 75%~91.7%. Conclusion The risk assessment system for unplanned extubation of inpatients based on Delphi method is scientific, which can guide clinical nursing work effectively.