The Study of Building a Behavior Identification System to Prevent Unplanned Extubation

• Main Authors: Pei-Ling Wang, 王佩麟
• Other Authors: Li Lu
• Format: Others
• Language: zh-TW
• Published: 2009
• Online Access: http://ndltd.ncl.edu.tw/handle/08699766035410724023

碩士 === 臺北醫學大學 === 醫學資訊研究所 === 97 === At the same time the medical technology has developed rapidly, the patient safety has also made much attention gradually. The first step of「safety」is「freedom from accidental injury」(Institute of Medicine, 2000). A number of unplanned extubation taken place in critical care unit. When an accidental extubation occurred, it often caused the extended usage of mechanical ventilator、prolong the length of hospital stay、arrhythmia、hemodynamically unstable and even triggered serious complications to patients. Unplanned extubation ratio is an indicator of healthcare quality in ICU, how to prevent and reduce the unplanned endotracheal extubation becomes one of the most critical issues for hospitals. >From many studies, we found the major type of caused factors for unplanned endotracheal extubation come from the self-extubation, i.e. the patient removes the endotracheal tube himself. However, among the preventive measures such as staff education、increasing safety during nursing interventions、communications、use of restraints in patient''s and sedation protocols and so on, most of them have been practiced in hospitals but it seemed that the outcome is yet satisfactory after all. Our subject of this research is to evaluate the feasibility of developing a behavior identification system among various possibilities. The goal of our study is to help professionals to build up a preventive self-extubation behavior identification system to meet the needs of care. Therefore, to increase the success rate and apply resources more effectively, we chose in this study the most appropriate behavior identification systems from various decision making analysis that act as the research reference for the base of future product development. We hope the developers can take the outcome of this study as their solution proposal while their building the extubation behavior identification system, and to monitor correctly at bedside and raise alert signals to healthcare givers to avoid extubation from patients themselves and eventually, to improve the patient safety among others. In this study, we use the Delphi method and design expert questionnaire of 「Building the Extubation Behavior Identification System」for the decision-making factors where includes: 「maturity of technology of sensing equipment」、 「facilitation of development for behavior identification system」、「accuracy of behavior identification system」、「feasibility of monitoring equipment for clinical care」、「safety of bedside monitoring equipment」and 「cost of implementation」. Also, we have analyzed systems such as RFID system、accelerometer identification system、infrared ray sensing identification system、magnetic sensing identification system and digital glove identification system to be the alternatives. With the Analytic Hierarchy Process (AHP), the experts compared and weighted the relatively importance among different levels by using Expert Choice v.11.5. The result of this analysis for alternative system in the order of priority is : accelerometer identification system、digital glove identification system、RFID system、infrared ray sensing identification system and magnetic sensing identification system. The result of this study were acquired by the experiences from the experts of Informatics、Medical Equipment and Clinical Care, that has concluded the accelerometer identification system is the first priority of choice for developers when they consider to build up the Extubation Behavior Identification System to improve the patient safety in the near future.