Objective To explore the effect of anticipatory care based on healthcare failure mode and effects analysis（HFMEA） on the prevention of unplanned extubation（UEX） in orthopedic surgery patients.Methods Forty-one patients who underwent orthopedic surgery with indwelling drains in a hospital in Henan Province from January 2017 to January 2018 were selected as the control group

and another 43 patients who underwent orthopedic surgery with indwelling drains in the same hospital from February 2018 to February 2019 were selected as the study group.Patients in the control group were given conventional care

and patients in the study group were given HFMEA-based anticipatory care based on the control group.The incidence of UEX

UEX risk awareness and nursing satisfaction were compared between the 2 groups.Results The UEX incidence of the study group was 6.98%

which was lower than that of the control group（24.39%）

and the difference was statistically significant（P<0.05）.the UEX risk awareness scores of personal factors

environmental factors

and disease factors of the two groups were higher than those before the intervention

and the study group significantly outperformed the control group（P<0.05）.Patients in the study group had higher satisfaction scores for nursing staff health education

operational skills

and nursing program than the control group

and all differences were statistically significant（P<0.05）.Conclusion HFMEA-based anticipatory care used for orthopedic surgery patients can effectively prevent the occurrence of UEX and improve patients’ UEX risk awareness and nursing satisfaction.