Development of a Nursing care System for Patients at Risk of Reintubation within 24 Hours Following General Anesthesia
Keywords:
Anesthetic nursing system, Reintubation, Nursing risk management, Donabedian Model, General anesthesiaAbstract
The occurrence of complications from reintubation within 24 hours after general anesthesia is a significant issue that impacts patient safety, quality of life, and medical resources. This study aims to develop a nursing care system for patients at risk of reintubation within 24 hours after general anesthesia and to evaluate the outcomes of the developed system. The conceptual framework used is the Donabedian Model, which comprises three components: structure, process, and outcome. This action research was conducted at Nakhon Pathom Hospital over a period of 5 months and was divided into three phases: (1) assessment of risk management in anesthetic nursing, (2) development of a prototype nursing system using the 3P process (Purpose, Process, Performance), and (3) evaluation of the outcomes of the developed system.
The results of Phase 1 revealed that the strengths of the current risk management system lie in the close monitoring of patients. however, it lacks standardized information transfer and adequate resource allocation. Phase 2 involved the development of a prototype system consisting of (1) preparation before anesthesia, including a Risk Assessment Form, (2) establishment of guidelines to prevent reintubation after general anesthesia, and (3) development of information transfer protocols between the recovery room and inpatient wards. Phase 3 evaluation showed that the reintubation rate decreased from 0.15% to 0.05%. Satisfaction (M=4.57) and confidence (M=4.67) in the system among anesthetic nurses and inpatient nurses after implementation were at the highest levels.
References
Steadman J, Catalani B, Sharp C, Cooper L. Life-threatening perioperative anesthetic complications: Major issues surrounding perioperative morbidity and mortality. Trauma Surg Acute Care Open. 2017;2(1). https://doi.org/10.1136/tsaco-2017-000113
Maggiore SM, Jaber S, Grieco DL, et al. High-flow versus Venturi mask oxygen therapy to prevent reintubation in hypoxemic patients after extubation: A multicenter randomized clinical trial. Am J Respir Crit Care Med. 2022;206(12):1452–62. https://doi.org/10.1164/rccm.202201-0065OC
Tanaka A, Shimomura Y, Uchiyama A, et al. Time definition of reintubation most relevant to patient outcomes in critically ill patients: A multicenter cohort study. Crit Care. 2023;27:378. https://doi.org/10.1186/s13054-023-04668-3
สมรัตน์ จารุลักษณานันท์. โครงการวิจัยสหสถาบัน เรื่อง การศึกษาอัตราการเสียชีวิต และภาวะแทรกซ้อนทางวิสัญญีจากการรายงานอุบัติการณ์ในประเทศไทย. กรุงเทพฯ: สถาบันวิจัยระบบสาธารณสุข (สวรส.); 2560.
โรงพยาบาลนครปฐม. รายงานภาวะแทรกซ้อนจากการใช้ยาระงับความรู้สึกในช่วงก่อน ระหว่าง และหลังการผ่าตัด; 2564-2567.
ชลิตา แสงจันทร์. อุบัติการณ์และสาเหตุการใส่ท่อช่วยหายใจซ้ำหลังการให้ยาระงับความรู้สึกแบบทั่วไปในโรงพยาบาลสงขลา. วารสารศาสตร์สุขภาพและการศึกษา. 2565;2(1):15–27.
Choovongkomol C, Ariyanuchitkul T, Choovongkomol K, Tongjapo V. Independent predictors and clinical predictive score of postanesthetic reintubation after general anesthesia: A time-matched, case control study. J Anaesthesiol Clin Pharmacol. 2024;40(1):120–26. https://doi.org/10.4103/joacp.joacp_213_22
Cooper RM, Khan S. Extubation and reintubation of the difficult airway. In: Hagberg CA, editor. Benumof and Hagberg's airway management. 3rd ed. Philadelphia: Elsevier Saunders; 2013. p. 1018–46.e7. https://doi.org/10.1016/B978-1-4377-2764-7.00050-6
Chen S, Zhang Y, Che L, et al. Risk factors for unplanned reintubation caused by acute airway compromise after general anesthesia: a case-control study. BMC Anesthesiol. 2021;21:17. https://doi.org/10.1186/s12871-021-01238-4
Doyle P, Santhirapala V. Quality of life after anesthesia. Anesthesiol Clin. 2019;37(3):507–20.
Cooper RM, Khan S. Extubation and reintubation of the difficult airway. Benumof and Hagberg's airway management. 2013;1018–46.e7. https://doi.org/10.1016/B978-1-4377-2764-7.00050-6
Donabedian A. An introduction to quality assurance in health care. New York: Oxford University Press; 2003.
Landis JR, Koch GG. The Measurement of Observer Agreement for Categorical Data. Biometrics. 1977;33(1):159–174. doi:10.2307/2529310.
Kulp L, Sarcevic A, Zheng Y, Cheng M, Alberto E, Burd R. Checklist design reconsidered: Understanding checklist compliance and timing of interactions. Proc SIGCHI Conf Hum Factors Comput Syst. 2020;10. https://doi.org/10.1145/3313831.3376853
Salas E, Rosen MA. Building high reliability teams: Progress and some reflections on teamwork training. BMJ Qual Saf. 2013;22(5):369–73. https://doi.org/10.1136/bmjqs-2013-002015
De Meester K, Verspuy M, Monsieurs KG, Van Bogaert P. SBAR improves nurse-physician communication and reduces unexpected death: a pre and post intervention study. Resuscitation. 2013;84(9):1192-1196. doi:10.1016/j.resuscitation.2013.03.016
Muller M, Jürgens J, Redaèlli M, et alImpact of the communication and patient hand-off tool SBAR on patient safety: a systematic reviewBMJ Open 2018;8:e022202. doi: 10.1136/bmjopen-2018-022202
Ruhomauly Z, Betts K, Jayne-Coupe K, et al. Improving the quality of handover: implementing SBAR. Future Healthcare Journal. 2019;6(2):s54.
