Validation of a Risk Assessment Tool for Unplanned Endotracheal Extubation: An Observational Study

Abstract

The purpose of this study was to validate and determine the sensitivity and specificity of the risk assessment tool for unplanned endotracheal extubation. Unplanned endotracheal extubation is a common adverse event. The rate of unplanned endotracheal extubation is an indicator to measure patient safety and medical quality. This study was conducted in five intensive care units in a tertiary-A hospital. A total of 227 samples encounters were obtained from 147 unique patients. The content validity was 0.91, and the item content validity ranged from 0.80 to 1.00. Cronbach’s α was .58, the interrater reliability was .93. The area under the curve was 0.89 (95% CI [0.84, 0.94], p < 0.01), the sensitivity was 87.80%, and the specificity was 74.20%. This tool presented good reliability and validity and can be used to assess the risk of unplanned endotracheal extubation in patients with artificial airways.

Keywords

airway extubation risk assessment reliability and validity sensitivity specificity

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References

Z. P.

Gao

X. L.

Zhao

X. L.

(2018). Factors associated with unplanned extubation in the Intensive Care Unit for adult patients: A systematic review and meta-analysis. Intensive & Critical Care Nursing, 47, 62–68. https://doi.org/10.1016/j.iccn.2018.03.008

Aydoğan

Kaya

(2017). The Assessment of the risk of unplanned extubation in an adult intensive care unit. Dimensions of Critical Care Nursing, 36(1), 14–21. https://doi.org/10.1097/DCC.0000000000000216

Balmforth

J. E.

Thomas

A. N.

(2019). Unplanned removal of medical devices in critical care units in North West England between 2011 and 2016. American Journal of Critical Care, 28(3), 213–221. https://doi.org/10.4037/ajcc2019961

Ben

D. F.

Lü

K. Y.

Chen

X. L.

X. Y.

H. J.

Chang

Zhu

S. H.

Tang

H. T.

Xia

Z. F.

(2011). Unplanned decannulation of tracheotomy tube in massive burn patients: A retrospective case series study. Chinese Medical Journal, 124(20), 3309–3313. https://doi.org/10.3760/cma.j.issn.0366-6999.2011.20.019

Berkow

Kanowitz

(2020). COVID-19 putting patients at risk of unplanned extubation and airway providers at increased risk of contamination. Anesthesia and Analgesia, 131(1), e41–e43. https://doi.org/10.1213/ANE.0000000000004890

Chhina

A. K.

Loyd

G. E.

Szymanski

T. J.

Nowak

K. A.

Peruzzi

W. T.

Yeldo

N. S.

Han

Kerzabi

L. S.

Galusca

D. M.

Cazacu

Brodie

Penning

D. H.

(2020). Frequency and analysis of unplanned extubation in coronavirus disease 2019 patients. Critical Care Explorations, 2(12), e0291. https://doi.org/10.1097/CCE.0000000000000291

Chuang

M. L.

Lee

C. Y.

Chen

Y. F.

Huang

S. F.

Lin

I. F.

(2015). Revisiting unplanned endotracheal extubation and disease severity in intensive care units. PLoS One, 10(10), e0139864. https://doi.org/10.1371/journal.pone.0139864

Cicolini

Della Pelle

Cerratti

Franza

Flacco

M. E.

(2016). Validation of the Italian version of the Stanford Presenteeism Scale in nurses. Journal of Nursing Management, 24(5), 598–604. https://doi.org/10.1111/jonm.12362

Danielis

Chiaruttini

Palese

(2018). Unplanned extubations in an intensive care unit: Findings from a critical incident technique. Intensive & Critical Care Nursing, 47, 69–77. https://doi.org/10.1016/j.iccn.2018.04.012

10.

Danielis

Palese

Terzoni

Destrebecq

(2020). What nursing sensitive outcomes have been studied to-date among patients cared for in intensive care units? Findings from a scoping review. International Journal of Nursing Studies, 102, 103491. https://doi.org/10.1016/j.ijnurstu.2019.103491

11.

Devlin

J. W.

Skrobik

Gélinas

Needham

D. M.

Slooter

Pandharipande

P. P.

Watson

P. L.

Weinhouse

G. L.

Nunnally

M. E.

Rochwerg

Balas

M. C.

van den Boogaard

Bosma

K. J.

Brummel

N. E.

Chanques

Denehy

Drouot

Fraser

G. L.

Harris

J. E.

Joffe

A. M.

. . .Alhazzani

(2018). Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Critical Care Medicine, 46(9), e825–e873. https://doi.org/10.1097/CCM.0000000000003299

12.

Dou

Zhao

Chen

Zhao

Xiao

Wang

Zhang

Chen

Guo

Tao

(2018). Development and testing of the reliability and validity of the adolescent haze related knowledge awareness assessment scale (AHRKAAS). BMC Public Health, 18(1), 734. https://doi.org/10.1186/s12889-018-5638-8

13.

Ferketich

(1991). Focus on psychometrics. Aspects of item analysis. Research in Nursing & Health, 14(2), 165–168. https://doi.org/10.1002/nur.4770140211

14.

Henson

R. K.

(2001). Understanding internal consistency reliability estimates: A conceptual primer on coefficient alpha. Measurement and Evaluation in Counseling and Development, 34(3), 177–189. https://doi.org/10.1080/07481756.2002.12069034

15.

Kwon

Choi

(2017). Case-control study on risk factors of unplanned extubation based on patient safety model in critically ill patients with mechanical ventilation. Asian Nursing Research, 11(1), 74–78. https://doi.org/10.1016/j.anr.2017.03.004

16.

Lee

J. Y.

Park

H. A.

Chung

(2018). Use of electronic critical care flow sheet data to predict unplanned extubation in ICUs. International Journal of Medical Informatics, 117, 6–12. https://doi.org/10.1016/j.ijmedinf.2018.05.011

17.

Lellouche

Lavoie-Bérard

C. A.

Rousseau

Bouchard

P. A.

Lefebvre

J. C.

Branson

Brochard

(2021). How to avoid an epidemic of endotracheal tube occlusion. The Lancet Respiratory Medicine, 9(11), 1215–1216. https://doi.org/10.1016/S2213-2600(21)00404-5

18.

Moons

Boriau

Ferdinande

(2008). Self-extubation risk assessment tool: Predictive validity in a real-life setting. Nursing in Critical Care, 13(6), 310–314. https://doi.org/10.1111/j.1478-5153.2008.00305.x

19.

Morse

Tylko

(2010). Development of a scale to identify the fall-prone patient. Canadian Journal on Aging, 8(4), 366–377. https://doi.org/10.1017/s0714980800008576

20.

Peng

Z. M.

Liu

Zhang

(2020). Evaluation of reliability and validity of the Patient Health Questionnaire-9 in patients with acne. Dermatologic Therapy, 33(4), e13584. https://doi.org/10.1111/dth.13584

21.

Perez

Peters

Wilkes

Murphy

(2019). Physical restraints in intensive care-An integrative review. Australian Critical Care, 32(2), 165–174. https://doi.org/10.1016/j.aucc.2017.12.089

22.

Registered Nurses’ Association of Ontario. (2012). Promoting safety: Alternative approaches to the use of restraints. Author. Retrieved August 7, 2021, from https://rnao.ca/bpg/guidelines/promoting-safety-alternative-approaches-use-restraints

23.

Rose

Burry

Mallick

Luk

Cook

Fergusson

Dodek

Burns

Granton

Ferguson

Devlin

J. W.

Steinberg

Keenan

Reynolds

Tanios

Fowler

R. A.

Jacka

Olafson

Skrobik

Mehta

(2016). Prevalence, risk factors, and outcomes associated with physical restraint use in mechanically ventilated adults. Journal of Critical Care, 31(1), 31–35. https://doi.org/10.1016/j.jcrc.2015.09.011

24.

Siedlecki

S. L.

Albert

N. M.

(2017). Understanding interrater reliability and validity of risk assessment tools used to predict adverse clinical events. Clinical Nurse Specialist, 31(1), 23–29. https://doi.org/10.1097/NUR.0000000000000260

25.

Theeranut

Ninbanphot

Limpawattana

(2021). Comparison of four pressure ulcer risk assessment tools in critically ill patients. Nursing in Critical Care, 26(1), 48–54. https://doi.org/10.1111/nicc.12511

26.

Torres

G. M.

Nascimento

Hermida

Malfussi

Galetto

(2021). Care for unplanned extubation prevention: Analysis of the validity of an instrument’s content. Revista Brasileira de Enfermagem, 74(1), e20180998. https://doi.org/10.1590/0034-7167-2018-0998

27.

Vats

Hopkins

Hatfield

K. M.

Yan

Palmer

Keskinocak

(2017). An airway risk assessment score for unplanned extubation in intensive care pediatric patients. Pediatric Critical Care Medicine, 18(7), 661–666. https://doi.org/10.1097/PCC.0000000000001189

28.

Wang

B. H.

Zhang

J. J.

Zhang

Zhu

Yan

Q. Y.

(2019). The development and psychometric testing of Inpatients’ Involvement in Medication Safety Scale (IIMSS). Journal of Nursing Management, 27(8), 1648–1654. https://doi.org/10.1111/jonm.12852

29.

Yin

Yang

Sun

Yun

Wang

(2020). A comparative evaluation of three common airway humidification methods for patients with severe traumatic brain injury. Annals of Palliative Medicine, 9(6), 4137–4145. https://doi.org/10.21037/apm-20-2135

30.

Zhang

Liu

L. P.

(2021). Design of assessment tool for unplanned endotracheal extubation of artificial airway patients. Nursing Open, 8(4), 1696–1703. https://doi.org/10.1002/nop2.807

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