110例中高危管道非计划性拔管的原因分析与护理对策

Cause analysis of 110 cases of unplanned extubation with moderate to high risk tube and nursing strategy

目的:分析中高危管道非计划性拔管原因,发现拔管高危因素,为制订有效预防拔管对策提供科学依据。方法:回顾性分析本院2013年1月-2017年12月上报110例非计划性拔管事件,统计分析高危因素。结果:非计划性拔管54%为高危管道;拔管高危因素分析。①患者方面高危因素重症(42%)、60~80岁(44%)、使用镇静药(33%)、神志清醒(84%)、烦躁(54%)、无法行动(79%)、无约束(70%)。②护士方面分析:意外拔管65.45%发生在夜班;49%发生于护士做治疗护理期间,且57.27%为低年资护士。结论:制订相应对策可有效预防非计划性拔管,对策包括评估非计划性拔管高危因素,注重患者巡视护理,加强低年资护士培训,提高护士预防非计划性拔管意识。

Objective:To analyze the causes for unplanned extubation of moderate to high risk tube,to identify high risk factors for extubation,and to provide effective and scientific strategy for preventing extubation.Methods:110 cases of unplanned extubation were analyzed retrospectively from January,2013 to December,2017 to identify high risk factor.Results:54%of unplanned extubation occurs in patients with high risk tube.High risk factors for extubation include(1)Patient criteria:critical condition(42%),age:60-80 years old(44%),sedation(33%),consciousness(84%),agitation(54%),immobility(79%),no restraints(70%).(2)Nurse criteria:65.45%cases happened during night-shifts,49%cases happened during nursing care,and 57.27%cases were associated with junior nurses.Conclusion:Strategies that should be established to effectively prevent unplanned extubation include evaluating high risk factors for unplanned extubation,improve surveillance bedside,encourage continuous education for junior nurses,and improve awareness of nurses for preventing unplanned extubation.