Development of Prevention Guidelines for Unplanned Extubations, Surgical Intensive Care Unit, Mahasarakham Hospital
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Abstract
Abstract
This research and development aimed to analyze the current situation, develop, implement, and evaluate guidelines for preventing unplanned extubations in the Surgical Intensive Care Unit (SICU) at Mahasarakham Hospital. The study was conducted in four phases: (1) situation analysis, (2) guideline development, quality verification, trial implementation, and improvement, (3) effectiveness verification, and (4) evaluation. The research was carried out from October 2022 to September 2023. The sample included 18 professional nurses who utilized the guidelines and 206 intubated patients in the SICU, selected through purposive sampling based on predefined criteria. Research instruments included focus group discussion guidelines, an unplanned extubation recording form, a nursing practice evaluation form, and a satisfaction assessment form for professional nurses. The Index of Item-Objective Congruence (IOC) values for these instruments were 0.67, 1.00, 1.00, and 1.00, respectively. Data were analyzed using descriptive statistics and content analysis.
The study results indicated that the developed guidelines comprised four components: (1) risk assessment for endotracheal tube dislodgement, (2) nursing care for intubated patients, (3) information provision and communication, and (4) interdisciplinary collaboration in preventing tube dislodgement. The implementation highlighted the guidelines' practicality, simplicity, and effectiveness. Patient outcomes demonstrated a declining trend in unplanned extubation rates, meeting the set performance indicators. Nursing outcomes showed high compliance with the guidelines (92.00–100.00%), with 95.00% of professional nurses reporting high satisfaction with their guidelines. The findings suggested that the developed guidelines were feasible, effective, and contextually suitable for the SICU. Continuous promotion and evaluation of guideline implementation were recommended to sustain and enhance the quality of nursing care for intubated patients.
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