Journal of Korean Clinical Nursing Research (임상간호연구)

Hospital Nurses Association (병원간호사회)
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Factor Associated with Injury Related to Home Mechanical Ventilation in General Ward Patients: A Retrospective Study

가정용 인공호흡기 관련 안전사고 특성 및 손상 영향 요인 분석: 상급종합병원 일반병동 환자 중심으로

  • Kim, Hyang Sook (Division of Nursing, Severance Hospital) ;
  • Choi, Mona (College of Nursing.Mo-Im Kim Nursing Research Institute, Yonsei University) ;
  • Yang, Yong Sook (College of Nursing, Yonsei University)
  • 김향숙 (세브란스병원) ;
  • 최모나 (연세대학교 간호대학.김모임간호학연구소) ;
  • 양용숙 (연세대학교 간호대학)
  • Received : 2020.03.31
  • Accepted : 2020.06.23
  • Published : 2020.08.31
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Abstract

Purpose: This study aims to describe the characteristics of safety incidents and factors associated with injury for patients with Home Mechanical Ventilation (HMV) at the hospital. Methods: This is a retrospective study. Data were collected from the work log of respiratory home care nurses and the patients' electronic medical records were investigated. In order to compare group differences, independent t-test and χ2 test were used. Associated factors with injury development were identified by generalized mixed modeling analysis controlling for age and gender. Results: A total of 304 patients on HMV were included in this study, among which 129 (42.4%) experienced 352 HMV-related incidents. Mean frequency of incidents for each patient was 5.11±3.98, ranged from 1 to 15 times. In 19.0% of the incidents, injury was developed. Types of incident and persons involved in the incidents were significantly associated with the patient's injury. In the case of the safety incidents, patient's injury was significantly higher in accidents caused by respiratory circuit problems compared to those caused by problems with the ventilator operation by the medical staff (coefficient=1.25, p=.020). In addition, in the case of those involved in the safety incidents, patient's injury was significantly higher in the accident caused by the patient family members or caregivers than that caused by the medical personnel (coefficient=1.25, p=.019). Conclusion: In order to minimize injury caused by incidents in patients with HMV, hospitals need to provide systemic education to their medical staff and caregivers to enhance awareness of the importance of reporting and safety management.

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References

  1. Simonds AK. Home mechanical ventilation: An overview. Annals of the American Thoracic Society. 2016;13(11):2035-2044. https://doi.org/10.1513/AnnalsATS.201606-454FR
  2. Hazenberg A, Kerstjens HA, Prins SC, Vermeulen KM, Wijkstra PJ. Initiation of home mechanical ventilation at home: Arandomised controlled trial of efficacy, feasibility and costs. Respiratory Medicine. 2014;108(9):1387-1395. https://doi.org/10.1016/j.rmed.2014.07.008
  3. López-Campos JL, Failde I, Masa JF, Benítez-Moya JM, Barrot E, Ayerbe R, et al. Factors related to quality of life in patients receiving home mechanical ventilation. Respiratory Medicine. 2008;102(4):605-612. https://doi.org/10.1016/j.rmed.2007.11.005
  4. Sison SM, Sivakumar GK, Caufield-Noll C, Greenough WB, Galiatsatos P. Survival outcomes of chronic mechanical ventilation based on venues of care: A systematic review. Poster session presented at: American Thoracic Society 2019 International Conference; 2019 May 17-22; Dallas, TX. https://doi.org/10.1164/ajrccm-conference.2019.199.1_MeetingAbstracts.A1636
  5. Murphy PB, Douiri A. Patients, caregivers and health system costs of home ventilation. Thorax. 2018;73(7):601-602. https://doi.org/10.1136/thoraxjnl-2018-211659
  6. Nonoyama M, Katz S, Amin R, Mckim D, Guerriere D, Coyte P, et al. Healthcare utilization and costs of pediatric home mechanical ventilation in Canada. European Respiratory Society. 2019;54(suppl 63):PA1043. https://doi.org/10.1183/13993003.congress-2019.PA1043
  7. Lloyd-Owen SJ, Donaldson GC, Ambrosino N, Escarabill J, Farre R, Fauroux B, et al. Patterns of home mechanical ventilation use in Europe: Results from the Eurovent survey. European Respiratory Journal. 2005;25(6):1025-1031. https://doi.org/10.1183/09031936.05.00066704
  8. Rose L, McKim DA, Katz SL, Leasa D, Nonoyama M, Pedersen C, et al. Home mechanical ventilation in Canada: A national survey. Respiratory Care. 2015;60(5):695-704. https://doi.org/10.4187/ respcare .036093
  9. Kim HI, Cho JH, Park SY, Lee YS, Chang Y, Choi WI, et al. Home mechanical ventilation use in South Korea based on National Health Insurance Service data. Respiratory Care. 2019;64(5):528-535. https://doi.org/10.4187/respcare.06310
  10. Brar N, Spiegler P. Can we reduce ventilator-associated pneumonia by performing early tracheostomy? Clinical Pulmonary Medicine. 2011;18(3):148. https://doi.org/10.1097/CPM.0b013e3182189eca
  11. Lewarski JS, Gay PC. Current issues in home mechanical ventilation. Chest. 2007;132(2):671-676. https://doi.org/10.1378/chest.07-0558
  12. Povitz M, Rose L, Shariff SZ, Leonard S, Welk B, Jenkyn KB, et al. Home mechanical ventilation: A12-year populationbased retrospective cohort study. Respiratory Care. 2018;63(4):380-387. https://doi.org/10.4187/respcare.05689
  13. Bagnasco A, Zanini M, Aleo G, Catania G, Sasso L. Simulation skill labs to support informal caregivers who care for patients requiring mechanical ventilation at home. European Respiratory Journal. 2018;52(suppl 62):PA3145. https://doi.org/10.1183/13993003.congress-2018.PA3145
  14. Aloush SM. Nurses' implementation of ventilator-associated pneumonia prevention guidelines: An observational study in Jordan. Nursing in Critical Care. 2018;23(3):147-151. https://doi.org/10.1111/nicc.12323
  15. Williams LM, Sharma S. Ventilator safety. In: StatPearls [Internet]. Treasure Island(FL): StatPearls Publishing; c2019 [updated 2020 Jan 30; cited 2020 May 7]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526044/.
  16. Baid H. Patient safety: Identifying and managing complications of mechanical ventilation. Critical Care Nursing Clinics of North America. 2016;28(4):451-462. https://doi.org/10.1016/j.cnc.2016.07.005
  17. Kamio T, Masamune K. Mechanical ventilation-related safety incidents in general care wards and ICU settings. Respiratory Care. 2018;63(10):1246-1252. https://doi.org/10.4187/respcare.06109
  18. Cho SH, Go MG, Jung JH, Won SY, Lee HO, Nam JM, et al. A survey on nurses' and physicians' knowledge and educational needs on home ventilator. Journal of Korean Critical Care Nursing. 2012;5(1):56-66.
  19. Min HJ, Kwon HY, Shin CW, Ha YJ, Kim HJ. Factors influencing stress of nurse who care for patients using a mome mechanical ventilator in general ward. Journal of Korean Academic Society of Home Health Care Nursing. 2019;26(1):91-101. https://doi.org/10.22705/jkashcn.2019.26.1.91
  20. Stuban SL. Home mechanical ventilation. American Journal of Nursing. 2010;110(5):63-67. https://doi.org/10.1097/01.NAJ.0000372080.63145.13
  21. King AC. Long-term home mechanical ventilation in the United States. Respiratory Care. 2012;57(6):921-932. https://doi.org/10.4187/respcare.01741
  22. Lowery WS. Ventilator-disconnect and death: A case study and a safety device. Respiratory Care. 2010;55(6):774-776.
  23. Thomas AN, Galvin I. Patient safety incidents associated with equipment in critical care: A review of reports to the UK National Patient Safety Agency. Anaesthesia. 2008;63(11):1193-1197. https://doi.org/10.1111/j.1365-2044.2008.05607.x
  24. Joyner MK, Afolabi FC, Payne TL, Hueckel RM. Structured documentation of home ventilator settings in children: A quality improvement project. Journal of Pediatric Health Care. 2017;31(1):111-121. https://doi.org/10.1016/j.pedhc.2016.05.005
  25. Clemente F, Faiella G, Rutoli G, Bifulco P, Romano M, Cesarelli M. Critical failures in the use of home ventilation medical equipment. Heliyon. 2019;5(12):e03034. https://doi.org/10.1016/j.heliyon.2019.e03034
  26. Pham JC, Williams TL, Sparnon EM, Cillie TK, Scharen HF, Marella WM. Ventilator-related adverse events: A taxonomy and findings from 3 incident reporting systems. Respiratory Care. 2016;61(5):621-631. https://doi.org/10.4187/respcare.04151
  27. World Health Organization, WHO Patient Safety. The conceptual framework for the International Classification for Patient Safety:Final technical report [Internet]. Version 1.1.Geneva: World Health Organization; 2010[cited 2020 May 7]. Report No.:WHO/IER/PSP/2010.2. Available from: https://www.who.int/patientsafety/implementation/taxonomy/ICPS-report/en/.
  28. Yang L, Nonoyama M, Pizzuti R, Bwititi P, John G. Home mechanical ventilation: A retrospective review of safety incidents using the World Health Organization International Patient Safety Event classification. Canadian Journal of Respiratory Therapy. 2016;52(3):85-91.
  29. Jang MS, Hwang MS. Comparison of hospital nurses' knowledge, emergency coping ability and educational need according to nursing care experience for patient applied the home mechanical ventilator. Journal of Korean Academic Society of Home Health Care Nursing. 2017;24(2):121-132. https://doi.org/10.22705/jkashcn.2017.24.2.121
  30. Kun SS, Deavenport-Saman AD, Keens TG, Ward SL, Takata GS. Rapid response and code events in hospitalized children on home mechanical ventilation. Respiratory Care. 2019;64(12):1461-1468. https://doi.org/10.4187/respcare.06402