[Care work load in critical patients. Comparative study NEMS versus NAS]. / Cargas de trabajo asistencial en pacientes críticos. Estudio comparativo NEMS frente a NAS.

INTRODUCTION: The systems of calculating care load have not yet reached the levels of generalized use which the systems of prognostic estimation of survival have. The reason for this is their potential defects of design (medical and not nursing conceptualization) and the sometimes confusing completion (TISS 76). The simplest ("nine equivalents of nurse manpower use score" [NEMS], care levels) add the difficulty of not being useful for the calculation of staff, because the design is not oriented towards nursing. The development of NAS (nursing activity score) by FRICE tries to solve all these problems. Our objective has been to verify to what degree the NEMS and NAS are correlated as systems of expression and calculation of care load. PATIENTS AND METHOD: During the last quarter of 2004, NEMS and NAS have been used simultaneously by the nursing staff. During this period, 150 pairs of daily calculation values of NEMS-NAS and 150 pairs of calculation values by shift of NEMS-NAS have been collected. Comparison of means and linear correlation of values obtained and the analysis of the histograms of values of each series, their value ranges and analysis of their bias coefficients have been done. The analysis was done with the SPSS/PC 11. RESULTS: During the period indicated, it has been verified that NEMS has a much narrower value range than NAS, both in regards to daily values (18-45 versus 29.70-84.50) and in regards to values by shift (18-45 versus 22.40-84.50). The bias analysis shows a deviation to the left of both series of values. Linear correlation between NEMS-NAS by shift shows a R2 of 0.1634 and becomes even poorer in the NEMS-NAS correlation per day with R2 of 0.2012. It should also be stressed that NEMS expresses its results in points while NAS does so in percentage of time occupied in the attention and care of the patient. CONCLUSIONS: In this preliminary study, the better adaptation of NAS versus NEMS to real work loads of patients hospitalized in the ICU and the non-possible correlation between the values of both systems is affirmed.

Cargas de trabajo asistencial en pacientes críticos. Estudio comparativo NEMS frente a NAS / Care work load in critical patients. Comparative study NEMS versus NAS

Introducción. Los sistemas de cómputo de carga asistencial no han alcanzado aún los niveles de utilización generalizada que poseen los sistemas de estimación pronóstica de supervivencia. La causa de ello son sus potenciales defectos de diseño (conceptualización médica y no de enfermería) y la, a veces, farragosa cumplimentación (TISS 76). Los más simples (NEMS [nine equivalents of nursing manpower use score], niveles de asistencia) añaden la dificultad de no ser útil es para el cálculo de plantillas, debido a un diseño no orientado a enfermería. El desarrollo de NAS (nursing activity score) por FRICE® intenta solventar todos estos problemas. Nuestro objetivo ha sido comprobar en qué medida se correlacionan NEMS y NAS como sistemas de expresión y computo de carga asistencial. Pacientes y método. Durante el último trimestre de 2004 se han utilizado simultáneamente NEMS y NAS, por parte del personal de enfermería. Durante este período se han recogido 150 pares de valores de cómputo diario de NEMS-NAS y 150 pares de valores de cómputo por turno de NEMS-NAS. Se ha realizado la comparación de medias y la correlación lineal de valores obtenidos, así como el análisis de los histogramas de valores de cada serie, sus rangos de valor y el análisis de sus coeficientes de sesgo. El análisis se ha realizado mediante SPSS/PC 11. Resultados. Durante el período señalado se ha constatado que NEMS tiene un rango de valor mucho más estrecho que NAS, tanto en lo que se refiere a valores diarios (18-45 frente a 29,70-84,50) como a valores por turno (18-45 frente a 22,40-84,50). El análisis de sesgo muestra una desviación a la izquierda de ambas series de valores. La correlación lineal entre NEMS-NAS por turno, muestra una R2 de 0,1634, y se empobrece aún más en la correlación NEMS-NAS por día con R2 de 0,0212. Debe destacarse, además, que NEMS expresa sus resultados en puntos, mientras que NAS lo hace en porcentaje de tiempo ocupado en la atención y cuidado del paciente. Conclusiones. En este estudio preliminar se constata la mejor adecuación de NAS frente a NEMS a las reales cargas de trabajo de los pacientes ingresados en UCI y la no posible correlación entre los valores de ambos sistemas

Introduction. The systems of calculating care load have not yet reached the levels of generalized use which the systems of prognostic estimation of survival have. The reason for this is their potential defects of design (medical and not nursing conceptulalization) and the sometimes confusing completion (TISS 76). The simplest («nine equivalents of nurse manpower use score» [NEMS], care levels) add the difficulty of not being useful for the calculation of staff, because the design is not oriented towards nursing. The development of NAS (nursing activity score) by FRICE® tries to solve all these problems. Our objective has been to verify to what degree the NEMS and NAS are correlated as systems of expression and calculation of care load. Patients and method. During the last quarter of 2004, NEMS and NAS have been used simultaneously by the nursing staff. During this period, 150 pairs of daily calculation values of NEMS-NAS and 150 pairs of calculation values by shift of NEMS-NAS have been collected. Comparison of means and linear correlation of values obtained and the analysis of the histograms of values of each series, their value ranges and analysis of their bias coefficients have been done. The analysis was done with the SPSS/PC 11. Results. During the period indicated, it has been verified that NEMS has a much narrower value range than NAS, both in regards to daily values (18-45 versus 29.70-84.50) and in regards to values by shift (18-45 versus 22.40-84.50). The bias analysis shows a deviation to the left of both series of values. Linear correlation between NEMS-NAS by shift shows a R2 of 0.1634 and becomes even poorer in the NEMS-NAS correlation per day with R2 of 0.2012. It should also be stressed that NEMS expresses its results in points while NAS does so in percentage of time occupied in the attention and care of the patient. Conclusions. In this preliminary study, the better adaptation of NAS versus NEMS to real work loads of patients hospitalized in the ICU and the non-possible correlation between the values of both systems is affirmed

[Nursing Activity Score (NAS). Our experience with a nursing load calculation system based on times]. / Nursing Activity Score (NAS). Nuestra experiencia con un sistema de cómputo de cargas de enfermería basado en tiempos.

INTRODUCTION: The load calculation systems of nursing work in the ICU has not had the same success in its introduction as the prognostic survival estimation systems. It causes may be: a medical design not oriented towards nursing (Therapeutic Intervention Scoring System--TISS in all its versions), lack of adaptation to the calculating of staff (Nursing Manpower Use Score--NEMS, care levels) and demand for permanent technological up-dating. In 2003, NAS was published in an attempt to obviate all the problems expressed. Its result expresses the percentage of nursing work time required for attention to each patient. Our objective has been to apply the method in our ICU and evaluate its results. PATIENTS AND METHODS: During the last quarter of 2004, NAS was systematically applied to all the patients admitted to our ICU, regardless of the reason for admission and stay time in the Unit. The analysis of this application was done by SPSS/PC 11. RESULTS: NAS calculations of 350 patients, which represents 1880 total registers, were collected during the mentioned period. The NAS result of the first day was analyzed, 40.8 +/- 14.1, comparing it with its evolution during all the stay days of each patient, until reaching the ICU discharge date (39.3 +/- 12.7). The mean stay of our series has been 4.3 +/- 5.4 days during this period and the total accumulated NAS per patient was 196.2 +/- 279.8. There was no good correlation (R2: 0.273) between the NAS score on the first day of stay in the ICU but there was between total NAS and total stay of each case (R2: 0.958). Translated into times, this implies that one nurse can care for (by shift and average) 2.5 patients in our ICU. CONCLUSIONS: This system adapts, without demands of periodic up-dating, to the real nursing work in the ICU. Its design is oriented to nursing work, regardless of the disease that justifies admission to the ICU. It is useful to adequately evaluate the nursing staff in the conventional ICU.

Nursing Activity Score (NAS). Nuestra experiencia con un sistema de cómputo de cargas de enfermería basado en tiempos / Nursing Activity Score (NAS). Our experience with a nursing load calculation system based on times

Introducción: Los sistemas de cómputo de cargas de trabajo de enfermería en unidad de cuidados intensivos (UCI) no han gozado del mismo éxito, en su implantación, que los sistemas de estimación pronóstica de supervivencia. Las causas de ello pueden ser: un diseño médico no orientado a enfermería (Therapeutic Intervention Scoring System [TISS] en todas sus versiones), una falta de adaptación al cálculo de plantillas (nine equivalents of nursing manpower use score [NEMS], niveles de asistencia) y una exigencia de permanente actualización tecnológica. En 2003, se publica el Nursing Activity Score (NAS), en un intento de obviar todos los problemas expresados y cuyo resultado expresa el porcentaje de tiempo de trabajo de enfermería que requiere la atención de cada paciente. Nuestro objetivo ha sido aplicar el método en nuestra UCI y evaluar sus resultados. Pacientes y métodos: Durante el último trimestre de 2004 se aplicó el NAS sistemáticamente a todos los pacientes ingresados en nuestra UCI, con independencia del motivo de ingreso y el tiempo de estancia en la unidad. El análisis de esta aplicación se ha realizado mediante SPSS/PC 11. Resultados: Se han recogido, durante el período citado, cómputos de NAS de 350 pacientes, lo que representa 1.880 registros totales. Se ha analizado el resultado de NAS del primer día 40,8 ± 14,1 y se ha comparado con su evolución durante todos los días de estancia de cada paciente, hasta alcanzar el día de alta de la UCI (39,3 ± 12,7). La estancia media de nuestra serie ha sido durante este período de 4,3 ± 5,4 días, y el NAS acumulado total por paciente de 196,2 ± 279,8. No existió buena correlación (R2 = 0,273) entre la puntuación NAS del primer día de estancia en UCI, y sí la hubo entre NAS total y estancia total de cada caso (R2 = 0,958). Traducido en tiempos, esto implica que una enfermera puede atender (por turno y promedio) en nuestra UCI a 2,5 pacientes. Conclusiones: Este sistema se adapta, sin exigencias de actualización periódica, al trabajo real de la enfermería en UCI, su diseño esta orientado al trabajo de enfermería, con independencia de la patología que justifica el ingreso en UCI y es útil para evaluar, adecuadamente, la plantilla de enfermería en una UCI convencional

Introduction: The load calculation systems of nursing work in the ICU has not had the same success in its introduction as the prognostic survival estimation systems. It causes may be: a medical design not oriented towards nursing (Therapeutic Intervention Scoring System - TISS in all its versions), lack of adaptation to the calculatin of staff (Nursing Manpower Use Score - NEMS, care levels) and demand for permanent technological up-dating. In 2003, NAS was published in an attempt to obviate all the problems expressed. Its result expresses the percentage of nursing work time required for attention to each patient. Our objective has been to apply the method in our ICU and evaluate its results. Patients and Methods: During the last quarter of 2004, NAS was systematically applied to all the patients admitted to our ICU, regardless of the reason for admissin and stay time in the Unit. The analysis of this application was done by SPSS/PC 11. Results: NAS calculations of 350 patients, which represents 1880 total registers, were collected during the mentioned period. The NAS result of the first day was analyzed, 40.8 ± 14.1, comparing it with its evolution during all the stay days of each patient, until reaching the ICU discharge date (39.3 ± 12.7). The mean stay of our series has been 4.3 ± 5.4 days during this period and the total accumulated NAS per patient was 196.2 ± 279.8. There was no good correlation (R2: 0.273) between the NAS score on the first day of stay in the ICU but there was between total NAS and total stay of each case (R2: 0.958). Translated into times, this implies that one nurse can care for (by shift and average) 2.5 patients in our ICU. Conclusions: This system adapts, without demans of periodic up-dating, to the real nursing work in the ICU. Its design is oriented to nursing work, regardless of the disease that justifies admission to the ICU. It is useful to adequately evaluate the nursing staff in the conventional ICU