Development and Application of a Unplanned Extubation Assessment and Clinical Decision Support Information System

Area of Science:

• Medical Informatics
• Patient Safety
• Intensive Care Medicine

Background:

• Unplanned extubation (UE) in ICUs presents serious risks, including respiratory issues and mortality.
• Current prevention methods are hindered by late detection and inconsistent nursing practices.
• This study addresses the need for improved UE prevention and catheter management.

Purpose of the Study:

• To develop and evaluate an Unplanned Extubation Assessment and Clinical Decision Support Information System (UE-CDSS).
• To reduce the incidence of unplanned extubations in intensive care units.
• To enhance the standardization and effectiveness of catheter management.

Main Methods:

• Developed a UE-CDSS using C# and SQL Server, incorporating 12 risk indicators identified via Delphi consultation.
• The system includes modules for catheter maintenance, risk assessment, restraint support, and feedback.
• A pre-post study design compared UE incidence and catheter metrics before and after system implementation in a tertiary hospital ICU.

Main Results:

• UE incidence decreased significantly across all catheter classes (Class I: 1.08% to 0.38%; Class II: 1.36% to 0.27%; Class III: 0.44% to 0%).
• Catheter fixation rates improved significantly, with standardized restraint increasing from 96.61% to 98.83% (P<0.001).
• Nurse satisfaction was high, scoring 92.15±6.82/115, indicating good usability.

Conclusions:

• The UE-CDSS effectively reduces unplanned extubations and standardizes catheter care in ICUs.
• The system demonstrates clinical utility and positive nurse acceptance.
• Its closed-loop management framework offers practical guidance and a scalable approach to enhance patient safety.