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Researchers Anothai Chomchey BN.S. Ratchanee Sangsawang MN.S.

The Development of Clinical Nursing Practice Guidelines in the Prevention of : Accidental Extubation in N eonatal I ntensive C are U nit, Songklanagarind Hospital. Researchers Anothai Chomchey BN.S. Ratchanee Sangsawang MN.S. Background.

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Researchers Anothai Chomchey BN.S. Ratchanee Sangsawang MN.S.

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  1. The Development of Clinical Nursing Practice Guidelines in the Prevention of : Accidental Extubation in Neonatal Intensive Care Unit, Songklanagarind Hospital Researchers AnothaiChomchey BN.S. RatchaneeSangsawang MN.S.

  2. Background • The incidence of accidental extubation in January – July 2014 was 35.65 per 1,000 Ventilator’s days. • NICU doesn’t have any written Clinical Nursing Practice Guidelines (CNPG) in the Prevention of: Accidental Extubation • - The nurses provide nursing cares to the newborn with prevention of accidental extubation differently. • Songklanagarind Hospital is a hospital with 853 beds. • Based on statistic from NICU the most commonly with prematurity (42.2%), heart disease (8.8%), surgery (13.3%), and lung disease (4.4%) • Endotracheal tube intubation averagely there are 21 cases per month.

  3. Purposes 1.To develop CNPG in the Prevention of: Accidental Extubation in Neonatal Intensive Care Unit, Songklanagarind Hospital 2.To examine the result of the use of CNPG in the Prevention of: Accidental Extubation in Neonatal Intensive Care Unit, Songklanagarind Hospital.

  4. National Health and Medical Research Council (NHMRC), There are 8 activities in the development phase : Activity 1: To determine the problem and scope of the problem Activity 2: To set a working team to develop the CNPG Activity 3: To set objectives, target group, and results Activity 4: To search and evaluate empirical evidence Activity 5: To draft the CNPG Activity 6: To test validity and reliability by the experts Activity 7 : Implementation of the CNPG Activity 8 : Evaluation of CNPG guidelines for the development of clinical practice guidelines in 3 phases: 1. Development Phase 2. Dissemination and Implementation Phase Conceptual Framework 3. Evaluation Phase

  5. Population and Sample -Using Krejcie& Morgan Table (Krejcie& Morgan, 1970) - Including 41 nurses in NICU of Songklanagarind Hospital who has been working for 1 year at lease - 31 newborn with Intubation before applying the CNPG and 31 newborn with Intubation after applying the CNPG, 62 newborns in total.

  6. Instruments • Research instruments consist of: • 1. Evaluation of nursing practice for newborns to prevent unplanned endotracheal tube extubation • 2. Questionnaire on the satisfaction of nurses on the use of nursing practice • 3. Endotracheal tube extubation record • Content validity index (CVI) of the instruments were 1.0, 0.93, 0.98 respectively. The reliability test using Cronbach’s alpha coefficient was 1. Results There are 4 parts of results presentation : • Data were analyzed by using frequency and percentage Data Analysis

  7. The table1 : General information. * Persistent Pulmonary Hypertension of the Newborn: PPHN

  8. Table 2: Evaluation of the CNPG for Prevent Accidental Extubation in Neonatal Intensive Care Unit (NICU), Songklanagarind Hospital

  9. Table 2: Evaluation of the CNPG for Prevent Accidental Extubation in Neonatal Intensive Care Unit (NICU), Songklanagarind Hospital

  10. Table 2: Evaluation of the CNPG for Prevent Accidental Extubation in Neonatal Intensive Care Unit (NICU), Songklanagarind Hospital

  11. Table 2: Evaluation of the CNPG for Prevent Accidental Extubation in Neonatal Intensive Care Unit (NICU), Songklanagarind Hospital * number of time to perform the task per morning , afternoon and night shift during the period of 1 month.

  12. The table 3 : Comparison of Accidental Extubation

  13. The table4 :Nurses’s Satisfaction on the use of CNPG

  14. Discussion 2. Comparison of the incidence of Accidental extubation pre- and post- implementation of CNPG revealed a decrease from 16.04 to 6.37 per 1,000 Ventilator’s days. 1. Result of CNPG to prevent accidental extubation in NICU, Songklanagarind Hospital revealed that most of the nurses followed the practice (90%) 3. Nurses’ satisfaction on the implementation of CNPG in the NICU, was at high to highest level.

  15. Suggestion 2.To obtain the success in implementation of this CNPG, there should be an emphasis on the personnel to understand the practice guidelines fully so that they would be able to perform the practice in the same manner. There should be a review and improvement of the practice’s content to be up-to-date, and there should also be regular follow up and inspection which will lead to continual practice. 1.The limitation of this study is that the study only examine of the incidence of accidental extubation pre- and post implementation of the nursing practice in percentage. No statistical difference was indicated. Therefore, to use of the results from this study as a reference is limited. Further studies should be developed by adding a statistic value indicating the statistical difference.

  16. Thank you for your Attention

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