• 중환자간호학회지
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• 제11권3호
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• pp.45-57
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• 2018

Purpose : This study was performed to identify the influencing factors of unplanned intensive care unit (ICU) readmission. Methods : The study adopted a Rretrospective case control cohort design. Data were collected from the electronic medical records of 844 patients who had been discharged from the ICUs of a university hospital in Incheon from June 2014 to December 2014. Results : The study found the unplanned ICU readmission rate was to be 6.4%(n=54). From the univariate analysis revealed that, major symptoms at $1^{st}$ ICU admission, severity at $1^{st}$ ICU admission (CPSCS and APACHE II), duration of applying ventilator application during $1^{st}$ ICU admission, severity at $1^{st}$ discharge from ICU (CPSCS, APACHE II, and GCS), and application of $FiO_2$ with oxygen therapy, implementation of sputum expectoration methods, and length of stay of ICU at $1^{st}$ ICU discharge were appeared to be significant; further, decision tree model analysis revealed that while only 4 variables (sputum expectoration methods, length of stay of ICU, $FiO_2$ with oxygen therapy at $1^{st}$ ICU discharge, and major symptoms at $1^{st}$ ICU admission) were shown to be significant. Conclusions : Since sputum expectoration method was the most important factor to predictor of unplanned ICU readmission, a assessment tool for the patients' capability of sputum expectoration needs to should be developed and implemented, and standardized ICU discharge criteria, including the factors identified from the by empirical evidences, might should be developed to decrease the unplanned ICU readmission rate.

• 중환자간호학회지
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• 제16권3호
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• pp.24-33
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• 2023

Purpose : This study aims to establish an optimal cut-off score on the Braden scale for the assessment of pressure injury to detect pressure injury risks among inpatients in a South Korean tertiary hospital. Methods : This retrospective study used electronic medical records, from January to December 2022. A total of 654 patients were included in the study. Of these, 218 inpatients with pressure injuries and 436 without pressure injuries were classified and analyzed using 1:2 Propensity Score Matching (PSM), and the generalized estimating equation was performed using SPSS Version 26 and the R Machlt package program. Results : The cut-off value on the Braden scale for distinguishing pressure injury was 17 points, and the AUC (area under the ROC curve) was 0.531 (0.484-0.579). The sensitivity was 56.6% (45.5-67.7%) and the specificity was 69.7% (66.0-73.4%). With 17 points, the Braden scale cut-off distinguished those who had pressure injuries from those who did not at the time of admission (p < .03). In the pressure injury group, the Braden score on the day of the pressure injury was 14, with significant results in all subcategories except the moisture category. Conclusion : Our findings revealed that a cut-off value of 17 was optimal for predicting the risk of pressure injuries among tertiary hospital inpatients. Future studies should evaluate the optimal cut-off values in different clinical environments. Additionally, it is necessary to conduct multicenter large sample studies to verify the effectiveness of a 17 value in PI risk assessments.

• 임상간호연구
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• 제26권2호
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• pp.207-216
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• 2020

Purpose: The purpose of this study was to investigate the motor subtypes of delirium in patients in a Surgical Intensive Care Unit (SICU), and identify the factors related to the characteristics of patients according to the motor subtypes of delirium. Methods: Data were collected in the SICU of a tertiary hospital in ^⁎ city from October 2018 to June 2019. Delirium was detected using the Confusion Assessment Method for the ICU (CAM-ICU) and motor subtypes of delirium were measured with the Delirium Motor Subtype Scale (DMSS)-4. Patients' characteristics were obtained by using the electronic medical records. Descriptive statistics were used to analyze the data. Results: Among 1,112 patients, 172 patients showed delirium (15.5%). After excluding dementia patients and patients refusing to participate in the study, 126 patients included in the final analysis. Delirium patients were classified as hyperactive delirium (32.5%), hypoactive delirium (42.9%), mixed delirium (11.9%), and non-motor subtype delirium (12.7%). Conclusion: The study results suggest that hypoactive delirium is the most prevalent motor subtype of delirium in SICU. More application of ventilators, more administration of sedatives, more use of catheters, and higher nursing severity were reported for hypoactive delirium cases than hyperactive ones. Therefore, it is necessary to assess early the motor subtypes of delirium using structured tools and develop appropriate nursing interventions suitable for each subtype of delirium.

• 임상간호연구
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• 제26권2호
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• pp.198-206
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• 2020

Purpose: The rapid response team is a patient safety system that detects symptoms and signs of deteriorating inpatients and provides intervention and treatment. This study analyzed the factors influencing the activation time of the team. Methods: This is a descriptive correlation study that analyzed the electronic medical records of patients activated by the rapid response team. The collection period was from January 2014 to December 2017. We analyzed 278 pieces of data activated by the rapid response team for patients aged 16 years or older at C University S Hospital in Seoul. We employed the SPSS 23.0 program for data analysis. Results: The reasons for activation of the rapid response team were oxygen saturation of less than 90.0%, other causes, and change in consciousness. The most common diagnosis of activated patients was respiratory failure (32.4%). The average activation time was 153.43±286.05 min. The activation time was shortest during convulsions (13.29±7.32 min). For patients with a history of kidney disease (B=0.58, p=.008), in case of surgery (B=0.55, p<.001), if the first symptom is mediated by the physician (B=0.53, p=.007) the active time is often extended. On the other hand, activation time is reduced when consciousness changes (B=-0.51, p=.002), especially when oxygen saturation is below 90.0% (B=-0.64, p<.001). Conclusion: Based on the results of the study, it is expected that patients deteriorating in the general ward would be recognized early, which will help in the effective activation of the rapid response team.

• Journal of Korean Biological Nursing Science
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• 제6권2호
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• pp.57-68
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• 2004

The contrast medium is very commonly used in more than 90% of computed tomography(CT) scans. It is difficult to predict the occurrence of adverse reactions and the degree of adverse reactions are diverse from mild urticaria, itching, nausea, vomiting to even cardiopulmonary arrest. The purpose of this study was to evaluate the symptoms, occurrence rate and risk factors of the adverse reactions in patients after contrast injection during CT examinations. Two hundreds sixty-five patients showed symptoms of adverse reactions out of 71,117 adult patients who received intravenous contrast administration during CT scans from January 2003 to December 2003 at a general hospital. Data was collected by reviewing adverse reaction records and electronic medical record. The results of this study were as follows; 1. Adverse reactions occurred in 265 out of a total of 71,117 patients(0.37%). Clinical symptoms of adverse reactions were most commonly dermatologic problems such as urticaria(69.81%) and itching(63.02%), followed by dyspnea(14.34%), dizziness(11.70%), nausea(6.79%), and vomiting(7.17%). 2. Anaphylactoid reactions occurred in 47 out of a total of 265 patients, and their pattern of symptoms were most commonly related to cardiovascular system(90.91%), followed by respiratory system(82.22%), gastrointestinal system(51.72%), and dermatologic system(16.51%). Eleven patients were transferred to emergency room for further treatment and two patients needed cardiopulmonary resuscitation. 3. The adverse reactions were significantly more common in women than in men(0.46% vs.0.32%, p=.003) and in type D contrast medium than the others(p<.001). The occurrence rate of adverse reactions was not significantly different according to the age and infusion speed of the contrast medium.

• 근관절건강학회지
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• 제25권2호
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• pp.61-74
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• 2018

Purpose: The purpose of this study was to examine the factors affecting changes in Korean Knee Score (KKS) and ranges of motion (ROM) of the knee after the structured exercise programs for the patients with total knee arthroplasty. Methods: This was a retrospective study using electronic medical records from January 2015 to February 2017, and the subject of this study was a total of 124 out of 434 patients underwent total knee replacement operation. They took part in a structured step-by-step exercise program conducted by orthopedic nurses, and then were evaluated for KKS and Knee ROM for 12 weeks after operation. Results: Post-intervention scores increased significantly in the KKS subdomains including pain and symptoms (t=-22.31, p<.001), function (t=-20.68, p<.001), evaluation of floor life (t=-14.18, p<.001), socioemotional function (t=-28.94, p<.001) over time. As for the change in the ROM, knee extension (t=9.23, p<.001) and knee flexion (t=4.04, p<.001) showed a statistically significant changes over time. Conclusion: This study illuminated the factors affecting the changes in pain and symptom, physical function, evaluation of floor life, socioemotional function and range of motion after structured exercise training programs for knee arthritis patients.

• 간호행정학회지
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• 제17권1호
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• pp.66-73
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• 2011

Purpose: The purpose of this study was to demonstrate effects of a critical pathway (CP) for stroke patients seen in emergency rooms (ER). Method: The CP developed by the CP committee consisted of 8 criteria: behavior of doctors and nurses, laboratory tests, Image testing, medication, treatment, activity, and nutrition. According to application of CP, a control group (n=17) and experimental group (n=17) were defined. Time was checked by the electronic medical records. Result: Use of CP for stroke patients in the ER, resulted in a decreased length of stay in ER (t=2.341, p=.026), and time required for image testing (t=2.623, p=.021), and an increased number of patients using rtPA ($x^2$=4.802, p=.049). Time required for neurology doctor contact, for neurology doctor to see patient in the ER, and for report of blood tests decreased, but there were no statistical significance. Conclusion: Quick responses are most important in the ER, so CP for these patients is a very effective patient management tool. To reduce delay in stroke diagnosis, continuous education programs for similar symptoms are necessary. CPs for other patients in the ER should be developed, and studies on cost and satisfaction, as well as length of stay, should be done.

• 중환자간호학회지
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• 제15권3호
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• pp.88-100
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• 2022

Purpose : This study aimed to identify risk factors for unplanned reintubation after planned extubation and to analyze the clinical outcomes in patients admitted to the intensive care unit after cardiac surgery. Methods : The study examined patients who underwent intubation and planned extubation admitted to the intensive care unit after cardiac surgery between January 1, 2017, and December 31, 2021. The reintubation group comprised 58 patients underwent unplanned reintubation within 7 days of planned extubation. The maintenance group comprised 116 patients who did not undergo reintubation and were matched with the reintubation group using the rational for matching criteria. Data were collected retrospectively from electronic medical records. We used the independent t-test, Mann-Whitney U test, 𝑥²-test, Fisher's exact test, and logistic regression analysis with SPSS/WIN 27.0. Results : The multivariate logistic regression analysis demonstrated that albumin (odds ratio [OR]=0.38, 95% confidence interval [CI]=0.20-0.72), surgery time (OR=1.54, 95% CI=1.20-1.97), PaO₂ before extubation (OR=0.85 per 10 mmHg, 95% CI=0.75-0.97), postoperative arrhythmia (OR=2.82, 95% CI=1.22-6.51), reoperation due to bleeding (OR=4.65, 95% CI=1.27-17.07), and postoperative acute renal failure (OR=2.97, 95% CI=1.09-8.04) were risk factors for unplanned reintubation. The reintubation group had a higher in-hospital mortality rate (𝑥²=33.74, p<.001), longer intensive care unit stay (Z=-7.81, p<.001), and longer hospital stay than the maintenance group (Z=-8.29, p<.001). Conclusion : These results identified risk factors and clinical outcomes of unplanned reintubation after planned extubation after cardiac surgery. These findings should be considered when developing and managing an intervention program to prevent and reduce the incidence of unplanned reintubation.

• 한국의료질향상학회지
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• 제27권2호
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• pp.57-72
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• 2021

Purpose: At present, there are a variety of serious patient safety incidents related to problems in health information technology (HIT), specifically involving electronic medical records (EMRs). This emphasizes the need for an enhanced electronic medical record system (EMRS). As such, this study analyzed both the nature of and potential to prevent incidents associated with HIT/EMRS based on data from the Korea Patient Safety Reporting and Learning System (KOPS). Methods: This study analyzed patient safety incidents submitted to KOPS between August 2016 and December 2019. HIT keywords were used to extract HIT/EMRS incidents. Each case was reviewed to confirm whether the contributing factors were related to HIT/EMRS (HIT/EMRS-related incidents) and if the incident could have been prevented (HIT/EMRS-preventable incidents). The selected reports were summarized for general clarity (e.g., incident type, and degree of harm). Results: Of the 25,515 obtained reports, 2,664 incidents (10.4%) were HIT-related, while 2,525 (9.9%) were EMRS-related. HIT/EMRS-related incidents were the third largest type of incident followed by 'fall' and 'medication incidents.' More than 80% of HIT/EMRS-related incidents were medication-related, accounting for approximately one-third of the total number of medication incidents. Approximately 10% of HIT/EMRS-related incidents resulted in patient harm, with more than 94% of these deemed as preventable; further, sentinel events were wholly preventable. Conclusion: This study provides basic data for improving EMR use/safety standards based on real-world patient safety incidents. Such improvements entail the establishment of long-term plans, research, and incident analysis, thus ensuring a safe healthcare environment for patients and healthcare providers.

• 임상간호연구
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• 제23권2호
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• pp.202-210
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• 2017

Purpose: In this study an investigation was done of injuries from inpatient falls and diagnostic tests and treatment after falls to identify what factors affect the occurrence of injury from inpatient falls in a tertiary hospital. Methods: Data for this cross-sectional study were retrieved for 428 fall events from data reported between January 1 and December 31, 2015 and were retrieved from the patient-safety reporting system in the hospital's electronic health records. A multivariate logistic regression model was developed with STATA 13.0. Results: Of the patients, 197 (46.0%) had physical injuries due to falls, 119 (27.8%) were given further diagnostic tests, and 358 (83.6%) received treatment including close observation after inpatient falls. Logistic-regression results identified that age, department, and risk factors had significant impact on injuries from falls. Conclusion: Findings indicate that to reduce the severity of injury after inpatient falls, each hospital should regularly evaluate identified factors, design fall-prevention practices specialized for elders and vulnerable patients, and initiate environmental and equipment innovations.