Impact of Wound Dressing Changes on Nursing Workload in an Intensive Care Unit.

The objective of this study is to understand how the type of wound dressing changes (routine or frequent) in patients admitted to intensive care units influences nurses' workload. This study used a database of retrospective and analytical observational study from one Portuguese intensive care unit. The sample included 728 adult patients admitted between 2015 and 2019. The nursing workload was assessed by the TISS-28 scale, both at admission and at discharge. The linear regression results show that patients with frequent dressing changes are associated with a higher nursing workload, both at admission (Coef. 1.65; 95% CI [0.53; 2.77]) and discharge (Coef. 1.27; 95% CI [0.32; 2.22]). In addition, age influences the nursing workload; older people are associated with a higher nursing workload (at admission Coef. 0.07; 95% CI [0.04; 0.10]; at discharge Coef. 0.08; 95% CI [0.05; 0.10]). Additionally, an increase in nursing workload at admission would significantly increase the nursing workload at discharge (Coef. 0.27; 95% CI [0.21; 0.33]). The relative stability of the nursing workload over the studied years is also another important finding (the influence of studied years is non-significant). In conclusion, patients with frequent dressing changes presented higher TISS-28 scores when compared with patients with an exchange of routine dressings, which leads to a higher nursing workload.

The burden of not-weighted factors - Nursing workload in a medical Intensive Care Unit.

OBJECTIVES: Body weight and infection status affect nursing workload and are not accounted for in the Therapeutic Intervention Scoring System 28 (TISS-28) and Nine Equivalents of Nursing Manpower Use Score (NEMS). The objective of this study was to analyse the correlation between weight and infection status with TISS 28 and NEMS in a cohort of medical Intensive Care Unit patients. RESEARCH METHODOLOGY: A retrospective observational trial was conducted on the nursing records of 26 randomly selected patients over a 12-month period. TISS-28 and NEMS were calculated for each day of ICU stay. Infectious status was determined based on positive cultures to multi-resistant organisms while overweight and obesity were based on Body Mass Index. RESULTS: A total of 809 nursing shifts' activity records were analysed. There were 12 infected patients that required isolation, 14 overweight patients and 3 obese: 9 patients presented both conditions. Only the presence of both conditions was statistically associated with an increase in workload (TISS-28p-value = 0.041 and NEMS p-value = 0.011). CONCLUSIONS: Although TISS-28 and NEMS do not specifically consider body weight and infection status, their integration into nursing workload scores may improve the accuracy as management tools, increasing the quality of the cares provided.

Perfil dos pacientes de uma unidade de terapia intensiva baseado no TISS 28 / Profile of patients of an intensive care unit based on the TISS 28

Trata-se de uma pesquisa de caráter prospectivo, descritivo, com abordagem quantitativa baseada no TISS 28. Os objetivos do estudo são conhecer os valores do TISS 28 da unidade; identificar os procedimentos diários mais prevalentes realizados pela equipe de enfermagem de acordo com o TISS 28, e discutir a importância da avaliação do perfil dos pacientes de terapia intensiva. A média de permanência de internação foi de 8,8 dias. A classificação dos pacientes permaneceu de III a IV, denotando um perfil de gravidade. Foi apontado um percentual elevado de pacientes que necessitam de serviço especializado e de pessoal treinado.

This is a survey of a prospective, descriptive and quantitative approach based on TISS 28. The objectives of the study are to know the values of TISS 28 unit, to identify the most prevalent daily procedures performed by nursing staff according to TISS 28 and discuss the importance of evaluating the profile of intensive care patients. The average hospitalization time was of 8.8 days of hospitalization. The classification of patients remained III to IV, showing a profile of gravity. It was observed a large percentage of patients who require specialized treatment and trained personnel.

Esta es una investigación con enfoque prospectivo, descriptivo y cuantitativo basado en el TISS 28. Los objetivos del estudio son conocer los valores del TISS 28 de la unidad; identificar los procedimientos diarios de mayor prevalencia realizados por el personal de enfermería según el TISS 28 y discutir la importancia de evaluar el perfil de los pacientes de cuidados intensivos. El promedio de hospitalización fue de 8,8 días de hospitalización. La clasificación de los pacientes permaneció III a IV, lo que muestra un perfil de la gravedad. Fue señalando un gran porcentaje de pacientes que requieren personal especializado y entrenado.

Indicadores de Gravidade em Unidade de Terapia Intensiva: estudo comparativo entre o "Therapeutic Scoring System-28" e a sua versão reduzida / Severity indicators at the Intensive Care Unit: a comparative study between Therapeutic Intervention Scoring System-28 and its reduced version

Este estudo teve como propósito avaliar comparativamente o desempenho do TISS-28 e NEMS (Nine Equivalents of Nursing Manpower Score), instrumentos de medida de carga de trabalho e de gravidade indireta de pacientes críticos, nas primeiras e últimas 24 horas de internação dos pacientes na Unidade de Terapia Intensiva. A amostra foi constituída por 86 pacientes, com idade mínima de 18 anos, internados na UTI adulto de um hospital universitário do Município de São Paulo no período de junho, julho e agosto de 2001. Os resultados demonstraram que não houve diferença estatísticamente significativa das variáaveis evolução clínica e sexo (p=0,771), idade (p=0,682) e tempo de permanência (0,297). Observou-se diferença estatisticamente significativa (p=0,004) entre a procedência e a condição de saída da UTI. Pacientes provenientes da Unidade Semi-Intensiva foram os que apresentaram maior proporção de óbitos (55,6%) quando comparados aos da Unidade de Internação (35%), Pronto-Socorro (20,0%) e Centro-Cirúrgico (6,3%). Também, nesses pacientes, os escores do TISS-28 e NEMS, nas primeiras e últimas 24 horas na UTI foram significativamente maiores que os demais pacientes. Verificou-se que a diferença entre a média geral do TISS-28 e NEMS, na admissão, foi 3,2 pontos, enquanto que na alta essa diferença foi de apenas 0,1 ponto. Pacientes que foram a óbito, apresentaram média de TISS-28 e NEMS significamente maiores (p<0,001) aos que tiveram alta, tanto nas primeiras quanto nas últimas 24 horas de internação na UTI. Todos os escores, ou seja TISS-28 e NEMS (primeiras e últimas 24 horas) foram consideradas bons preditores da ocorrência de óbitos. No entanto, a comparação entre as curvas de ROC (Receiver Operating Characterist) e o Modelo de regressão logística comprovou a melhor habilidade do NEMS final na avaliação do prognóstico na UTI. Como conclusão, os resultados mostraram que NEMS ) é um instrumento preciso para a medida de carga de trabalho de enfermagem na UTI e de gravidade dos pacientes críticos, podendo substituir o TISS-28.

The objective of this study was to comparatively evaluate TISS-28 and NEMS (Nine Equivalents of Nursing Manpower Score) which are tools to measure the nursing work and severity of critical patients, within the first and last 24 hours of hospitalization at the Intensive Care Unit (ICU). The sample consisted of 86 patients, with minimum age of 18 years old, hospitalized in adult ICU of a university hospital of the city of São Paulo, during the period of June, Juland August 2001. The results showed no statisticaly significant difference regarding sex (p=0,771), age (p=0,682) and stay variables (p=0,297) and clinical evolution. A statistically significant diference (p=0,004) between origin and condition of discharge from the ICU was observed. Patients of the Semi-Intensive Care Unit presented a greater proportion of deaths (55,6%) when compared to those of the Hospitalization Unit (35%), First-aid (20,0%) and Surgical Center (6.3%). In these patients, TISS-28 and NEMS score, within the first and last 24 hours in the ICU, were significantly greater than in the other sick patients. The difference between the TISS-28 and NEMS overal average, at the time of admission was 3,2 points while at the time of discharge was 0,1. Patients who went to death presented significantly greater TISS-28 and NEMS means (p<0,002) than those who were discharge from hospital either in the first and ou 24 hours of hospitalization at the lCU. All scores, that is, TISS-28 and NEMS (first and last 24 hours) are considered good predictor for the occurrence of death. However, the comparision between the ROC (Receiver Operating Characteristic) and the Model of logistic regression proved to be the best ability of NEMS at the end of the prognostic evaluation at the ICU. Concluding, the results showed that NEMS is a precise instrument of critical to measure the nursing workload at the ICU and severity of critical patients being able to substitute the TISS-28.

Evolução da gravidade de pacientes adultos internados em uma Unidade de Terapia Intensiva / Evolution of the severity of adult patients admitted to an Intensive Care Unit

Trata-se de um estudo que teve por objetivos caracterizar a evolução da gravidade dos pacientes internados em uma Unidade de Terapia Intensiva (UTI), segundo o Simplified Acute Physiological Score (SAPS II) e o Therapeutic Intervention Scoring System-28 (TISS-28), e verificar a relação desses escores com a variável idade, tempo de permanência e condição de saída da unidade. Compuseram a amostra, 61 pacientes adultos, admitidos consecutivamente na UTI de um hospital geral do Vale do Paraíba, São Paulo, de 16 de março a 16 de maio de 2002. Diariamente, da admissão à alta da UTI, foram aplicados, por um único avaliador, os índices SAPS II e TISS-28 em cada paciente, tendo por base as informações do prontuário. Os resultados mostraram uma maioria de pacientes do sexo masculino, (65,57%), faixa etária predominante de 41 a 60 anos (39,34%), procedentes, em maior parte, do Centro Cirúrgico (45,90%), após cirurgia de urgência (45,90%). O tempo de permanência médio foi de 8,9 dias e a maioria dos pacientes (67,21%) recebeu alta para a unidade de internação. Observou-se uma mortalidade de 24,59%. As pontuações médias do TISS-28 e SAPS II dos pacientes durante a internação foi de, respectivamente, 19 e 27 pontos, com risco de mortalidade (RM) de 14,0%. Quanto à evolução diária da gravidade, foram observadas médias crescentes do TISS-28, SAPS II e RM, do primeiro ao trigésimo terceiro dia de internação na UTI, em contraposição a um número decrescente de pacientes. Verificou-se relação entre a pontuação média do TISS-28 e o tempo de permanência na UTI, assim como entre a pontuação média do SAPS II e a idade. Pacientes que sobreviveram apresentaram escores médios de TISS-28, SAPS II e respectivo RM significativamente menores do que os pacientes não sobreviventes. A utilização dos índices SAPS II e TISS-28 mostrou-se útil para a medida da evolução da gravidade e da carga de trabalho de enfermagem na UTI, devendo ser ) empregados como índices complementares.

This is a study that its objectives was to characterize an Intensive Care Unit (ICU) patients' gravity evolution, according to the Simplified Acute Physiological Score (SAPS II) and the Therapeutic Intervention Scoring System-28 (TISS-28), and to check the relation of this two scores with variables as: age, permanence period and discharge condition of ICU. That was part of the sample, 61 adult patients, admitted consecutively at a general hospital ICU of Vale do Paraíba, São Paulo state, from March, 16 to May, 16, 2002. Daily, from ICU admission to discharge, it was applicable, by an only evaluator, SAPS II e TISS-28 scores in each patient, based on the patient informations papers. Results showed most of male patients (65,6%), predominant age was from 41 to 60 years (39,3%), coming, mostly, from Operating Center (45,9%), after urgency surgery. Median permanence period was 8,9 days and most of patients (67,2%) went to hospital ward. It was observed 24,6% mortality rate. TISS-28 and SAPS II median scores during the ICU permanence period was, respectively, 19 and 27 points, with a Mortality Risk (MR) of 14,0%. About daily gravity evolution, it was observed increasing medians of TISS-28, SAPS II and MR, from first to thirty-third ICU day permanence, in opposition to a decreasing number of patients. It was verified a relation between median TISS-28 score and ICU permanence period, as well as between SAPS II median score and age. Survivors had TISS-28, SAPS II median scores and respective MR meaningfully smaller than non-survivors. SAPS II and TISS-28 scores uses has shown useful to measure gravity evolution and nursing working load at ICU, so they must be used as complementary scores.

The predictive value of APACHEⅡ and TISS-28 in the treatment to respiratory failure in acute exacerbation of chronic obstructive pulmonary disease / 中国实用内科杂志

Objective Estimating the treatment to respiratory failure in acute exacerbation of chronic obstructive pulmonary disease by scores in the form of quantitative assessment.Methods 156 patients with chronic obstructive pulmonary disease with acute exacerbation of respiratory failure in patients in the medical intensive care unit based on the worst value of the calculated APACHEⅡ score were grouped,divided into groups and pairs of oxygen the level of non-invasive positive pressure ventilation group.Based on the worst values calculated by the APACHEⅡ and TISS-28 score within 24 h after admission into MICU selected cases is re-grouped into an effective group of oxygen,BiPAP effective group and invasive ventilation group.Statistics separately for each group of patients with APACHEⅡ score and TISS-28 score range,length of stay.Results The invasive ventilation group APACHEⅡ score(27.44?6.79)and TISS-28 score(28.22?7.90)was significantly higher than the other groups(P0.05),invasive ventilation group and effective group MICU hours of BiPAP have significant difference(P