B 대학병원 내과 중환자실의 비계획적 발관 발생과 결과에 대한 조사연구

강경자,이희주 한국자료분석학회 2012 Journal of the Korean Data Analysis Society Vol.14 No.3

본 연구는 일개 대학 병원 내과중환자실에서 기관 내 삽관 환자의 비계획적 발관 정도, 환자와 담당 간호사의 상황적 특성을 확인, 발관 된 후 재삽관 정도를 확인하는 서술적 조사연구이다. 연구 기간은 2005부터 2009년까지 5년간, 총 136명의 비계획적 발관 사례를 대상으로 하였다. 연구결과 비계획적 발관률은 6.2%, 간호행위와 연관성이 있는 사고적 발관이 9.6%, 자가발관은 90.4%로 나타났다. 억제대 풀림 또는 부적절로 인한 발생은 55.1%, 비계획적 발관 직전 환자의 호흡기 의존도는 의존도가 낮은 경우가 27.2%, 비계획적 발관 후 재삽관 하지 않은 경우가 39.7%, 밤 근무 때 발생률은 45.6% 등으로 나타났다. 재삽관에 미치는 영향 요인은 의식이 명료하지 않을수록(OR: 2.506)과 밤 근무조일수록(OR: 2.205), 발관이유 중 억제대 부적절인 경우(OR: 0.228) 및 사건, 사고 등 기타원인이 있는 경우(OR: 0.339) 등으로 나타났다. 따라서 억제대 사용 및 적절한 진정제 투여 지침의 개발과 적용, 적기에 계획적 발관을 할 수 있는 지침, 밤근무 간호사의 비예측 발관의 위험요소 주지 및 주의 집중 요구 등이 필요함을 알 수 있었다. The purpose of this study was to identify outcomes and occurrence rate related to unplanned endotracheal extubation (UEE) patients of medical intensive care unit during 5 years from 2005 to 2009. The participants in this study were 136 patients. They experienced UEE in intensive care unit (ICU). We used structured data collection tool and chart reviews were used to collect data for additional data. UEE rate was 6.2%. Alert patients were higher rate among self extubation patients and Not sedated patients were 103 (75.7%). The main reason why it is important that inadequate restraints is applying to patient. Nursing activity is caring other patients at the same time when UEE is occurred. Nurse carrier below 6 month is 22.8%. Especially, critical time is from 10:30 pm to 4 am during night duty. Reintubation patient is 60.3%, the others is not needed reintubation after UEE. Mental state, more not alert (OR: 2.506), night duty (OR: 2.205), inappropriate restraint (OR: 0.228) & other accidents (OR: 0.339) were significantly related to reintubation. The results of this study indicate that is needed a prevention program for unplanned extubation. Adequate intervention should be served for intubated patients in ICU.

Study on an Unplanned Extubation Prevention Program (UEPP) for Intubated Patients in Intensive Care Unit

강경자,유미,Kang, Kyung-Ja,Yu, Mi The Society of Digital Policy and Management 2014 디지털융복합연구 Vol.12 No.3

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. 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.

간호대학생의 비계획적 발관에 대한 시뮬레이션 교육 경험

이현숙(HyunSook Zin Lee),송충숙(Chung Sook Song),윤성자(Sung Ja Yoon) 학습자중심교과교육학회 2021 학습자중심교과교육연구 Vol.21 No.11

목적 본 연구에서는 간호대학생의 비계획적 발관에 대한 시뮬레이션 교육 경험을 파악하기 위하여 실시된 질적연구로서 연구 질문은 ‘비계획적인 발관에 대한 시뮬레이션 교육 경험은 어떠한가?’이며, 본 연구를 통해서 도출된 실체이론을 통하여 간호대학생의 시뮬레이션 교육의 경험을 적절하게 할 수 있는 간호학적 개입 방안을 모색하고자 한다. 방법 연구 참여자는 일개 대학에 재학 중인 간호대학생 10명을 대상으로 하였으며, 2020년 9월의 한 달간 심층면담을 실시하였으며, 자료분석은 Corbin과 Strauss(2008)의 근거이론방법을 사용하였다. 결과 이에 따른 분석 결과 핵심 범주는 시뮬레이션 교육 경험에서 ‘자신의 존재에 가치를 부여하기’였고, ‘예상하지 못한 기관지 내관의 이탈’, ‘초조함’, ‘주위의 도움’, ‘직무수행의 자존감 회복’, ‘문제해결에 대한 자신감 함양’의 6개의 범주가 도출되었고, 18개의 하위 범주, 37개의 개념이 도출되었다. 결론 본 연구 결과를 통하여 간호대학생의 비계획적 발관에 대한 시뮬레이션 교육 경험을 심도 있게 이해하는 근거를 제공하며, 추후 간호대학생의 시뮬레이션 교육의 효과와 만족도를 향상시킬 수 있는 프로그램 개발에 도움이 되고자 한다. Objectives The purpose of this study is a qualitative study conducted to understand the experience of simulation education of unplanned attendance of nursing students. Methods Participants in the study were 10 nursing students attending a university, and in-depth interviews were conducted for the month of September 2020. The data analysis used the basis theory method in Corbin & Strauss (2008). As a result of this analysis, the core categories were ‘giving value to one s existence’ in the simulation education experience, and the categories were derived: ‘unexpected deviation from internal organs’, ‘urgent’, ‘help around’, ‘restoration of self-esteem in job performance’ and ‘building confidence in problem solving’. Results In open coding, six categories, 18 subcategories, and 37 concepts were derived. Conclusions It provides a basis for in-depth understanding of the unplanned experience of nursing college students and aims to help develop programs that can improve the effectiveness and satisfaction of nursing college students in the future.

기관튜브 고정방법에 따른 비계획적 발관율 비교

최은희,김진희,박미희,이주연 병원간호사회 2006 임상간호연구 Vol.12 No.2

Purpose: This study was executed to grasp the frequence of unplanned extubation of intubated patients in MICU and develop a new nursing intervention for preventing the unplanned extubation. Method: The subject of this study was 136 patients with intubation totally in MICU of C university hospital in Seoul. The collection period of the relative data were from 1st April to end of November in 2005. In the period, we had analyzed 50 patients in total including 43 patients of planned extubation and 7 patients of unplanned extubation. The computational analysis of all data was performed by SPSS 12.0 program. Result: In the view of the unplanned extubation rate of intubated patients, 7.1% of patients fixed by the old method were extubated. But in the new method, only 1.9% of patients are extubated. Improvement of the unplanned extubation rate was verified in a new fix method. Conclusion: In this study it is verified that a nursing intervention applying the new fix method can decrease the occurrence of unplanned extubation. Additional studies need to be performed to evaluate the new nursing intervention.

Study on an Unplanned Extubation Prevention Program (UEPP) for Intubated Patients in Intensive Care Unit

Kyung-Ja, Kang,Mi, Yu 한국디지털정책학회 2014 디지털융복합연구 Vol.12 No.3

F-138 Comparison of clinical outcomes between patients with unplanned extubation and planned extubation since introduction of high flow nasal oxygen cannula

( Jung-wan Yoo ),( Sunmi Ju ),( Seung Jun Lee ),( Yu Ji Cho ),( Yi Yeong Jeong ),( Jong Deog Lee ),( Ho Cheol Kim ) 대한결핵 및 호흡기학회 2017 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.124 No.-

Purpose: Clinical data comparing clinical outcomes between patients with unplanned extubation (UPE) and planned extubation (PE) are lacking since an introduction of high flow nasal cannula (HFNC). The aim of study was to compare clinical outcomes between unplanned and planned extubation and to evaluate the impact on HFNC on extubation outcomes. Methods: From May, 2014 to February, 2017, medical ICU patients receiving mechanical ventilation for at least 1 day were reviewed, retrospectively. Among them, patients who underwent planned or unplanned extubation were included. Results: Among two hundred three patients included, Thirty one (15.3%) patients and one hundred seventy two (84.7%) underwent UPE and PE, respectively. Duration from MV to extubation did not differ between two groups (6.2 ± 4.1 days in UPE vs 5.6 ± 4.3 days in PE, P=0.28). Postextubation respiratory failure (PERF) developed more frequently in patients with UPE than PE (61.3% vs 35.5%, P=0.007). 54.8% patients with UPE and 44.8% PE received HFNC after extubation. There were no difference regarding the rate of re-intubation (29% in UPE vs 22.8% in PE, P=0.454) and extubation failure (35.5% in UPE vs 23.3% in PE, P=0.148). ICU and hospital also mortality did not differ. HFNC was negatively associated with extubation failure (OR=0.23, 95% CI 0.065-0.808, P=0.022). Conclusion: Patients with UPE experienced PERF more frequently than those with PE, but clinical outcomes did not differ. HFNC may prevent extubation failure in patients with PERF.