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

Abstract

Background: Unplanned extubation (UE) poses significant risks to intensive care unit (ICU) patients, including respiratory complications and increased mortality. Existing preventive measures are limited by delayed detection and inconsistent nursing practices. This study aimed to develop and evaluate an Unplanned Extubation Assessment and Clinical Decision Support Information System (UE-CDSS) to reduce UE incidence and enhance catheter management.

Methods: The UE-CDSS was developed using a C#-based client-server architecture and SQL Server database, integrating 12 core risk indicators, including limb muscle strength, delirium status, and catheter type. The indicators were selected through two rounds of Delphi expert consultation. The system comprises five modules: catheter maintenance, risk assessment and restraint decision, critical patient restraint support, virtual catheter ward, and analysis and feedback. A pre-post study design was applied to compare UE incidence, catheter management metrics, and nurse satisfaction in a tertiary hospital ICU before (2021, n=1,059) and after (2022-2023, n=4,115) system implementation.

Results: UE incidence significantly declined for all catheter classes: Class I from 1.08% to 0.38%, Class II from 1.36% to 0.27%, and Class III from 0.44% to 0%. Catheter fixation rates improved from 97.21% to 99.50%, secondary fixation from 95.13% to 97.80%, and standardized restraint from 96.61% to 98.83% (all P<0.001). Nurse satisfaction scored 92.15±6.82/115, reflecting high usability.

Conclusion: The UE-CDSS effectively reduces UE incidence and enhances catheter care standardization, demonstrating clinical utility and nurse acceptance. The system's closed-loop management framework provides practical guidance for nurses and a scalable approach for improving patient safety in ICUs.