Development of AIR Bbundle to Prevent Reintubation due to Unplanned Extubation in the Operating Room, Nongkhai Hospital.

Abstract

This action research aimed to develop and evaluate the use of the AIR bundle guideline to prevent reintubation due to unplanned extubation (UE) in the operating room at Nongkhai Hospital. The process was divided into 3 phases: the 1) Preparation phase 2) Action phase, which included 4 steps: planning, action, observation, and reflection, implemented for 2 cycles, and 3) Evaluation phase. A purposive sampling of 13 nurse anesthetists and 440 patients who underwent surgery under general anesthesia with endotracheal intubation were divided into two groups of 220 participants, one group receiving standard care and the other receiving care using the new guidelines. The research instrument, which passed a quality assurance measurements based on content validity (index of item-objective congruence, IOC = 0.67-1) and reliability, consisted of the developed AIR bundle guidelines, an innovative endotracheal tube stabilization device, an assessment form to evaluate the feasibility of implementing the guidelines, questionnaires that measured satisfaction with using the innovative endotracheal tube stabilization device, questionnaires that measured satisfaction with using the guidelines, and the incidence of reintubation and unplanned extubation record forms. Demographic data, the feasibility of implementing the guidelines data, and satisfaction were analyzed using descriptive statistics.  Chi-squares, and Fisher’s exact tests were used to compare general information, reintubation incidence, and unplanned extubation between groups.

Results of the study found two main findings. Firstly, the developed AIR bundle guideline has 3 processes:                   1. Assessment of risk & Advice, 2. Intubation & Intensive care, and 3. Record & Readiness for safe extubation record form. Lastly, there were four results derrived from using the guidelines, including the guidelines have the possibility of being used at the high and highest level, nurse anesthetists were mostly satisfied with using the guideline at the high level and satisfied with the innovative endotracheal tube stabilization device at the high level, and the incidence of reintubation due to UE during surgery was significantly lower than before the guidelines were implemented. Therefore, the developed guidelines should be applied in operating rooms with a similar context to reduce the incidence of reintubation due to UE during surgery.