Norridge Matthew, While Alison E
King's College London, Florence Nightingale Faculty of Nursing and Midwifery, London, UK and Evelina London Children's Hospital, Guy's & Thomas' NHS Foundation Trust, London, UK.
King's College London, Florence Nightingale Faculty of Nursing and Midwifery, London, UK.
Nurs Crit Care. 2016 Sep;21(5):295-303. doi: 10.1111/nicc.12160. Epub 2015 Apr 17.
Unplanned extubations in PICU are used as a measure of quality in clinical governance strategies. While many factors, such as sedation or unit activity, impact negatively on unplanned extubations, high nurse-patient ratios reduce adverse patient events and improve patient safety. However, optimal nurse-patient ratios and the impact of the level of nursing expertise on the quality of care are unknown.
The study aimed to examine the impact of PICU nursing expertise on the unplanned extubations of children.
Audit and analysis of existing adverse event patient and nurse workforce data.
This single-centre study examined unplanned extubations at a mixed general and cardiac tertiary PICU in the UK. Routinely collected data from nursing and adverse incident databases were examined. The dataset included over 74,477 nurse allocations between August 2006 and April 2011. Unplanned extubations were the adverse event of interest.
A total of 78 unplanned extubations occurred between April 2006 and April 2011. The majority of unplanned extubations occurred when patients were looked after by junior nurses. The seniority of the nurse in-charge and the qualifications of the patient's nurse were not related to unplanned extubations. However, more unplanned extubations occurred at times of higher patient occupancy.
Nursing expertise and nurse-patient ratios were not related to unplanned extubations in this study. Further research is needed to explore the non-workforce factors such as the securing of endotracheal tubes, sedation levels and unit activity and their relationship with adverse events.
In paediatric intensive care units where nurse-patient ratios are high, further investigation is needed to establish what impact non-workforce factors have on unplanned extubations.
儿科重症监护病房（PICU）中的非计划性拔管被用作临床管理策略中质量的一项衡量指标。虽然许多因素，如镇静或科室活动，会对非计划性拔管产生负面影响，但高护士-患者配比可减少不良患者事件并提高患者安全性。然而，最佳护士-患者配比以及护理专业水平对护理质量的影响尚不清楚。
本研究旨在探讨PICU护理专业水平对儿童非计划性拔管的影响。
对现有的不良事件患者和护士人力数据进行审计与分析。
这项单中心研究在英国一家综合及心脏专科三级PICU中调查非计划性拔管情况。检查了从护理和不良事件数据库中常规收集的数据。数据集包括2006年8月至2011年4月期间超过74477次护士分配情况。非计划性拔管是所关注的不良事件。
2006年4月至2011年4月期间共发生78次非计划性拔管。大多数非计划性拔管发生在患者由初级护士护理时。负责护士的资历和患者护士的资质与非计划性拔管无关。然而，在患者入住率较高时发生了更多非计划性拔管。
在本研究中，护理专业水平和护士-患者配比与非计划性拔管无关。需要进一步研究以探索诸如气管内导管固定、镇静水平和科室活动等非人力因素及其与不良事件的关系。
在护士-患者配比高的儿科重症监护病房，需要进一步调查以确定非人力因素对非计划性拔管有何影响。
