Comparison of nursing workload in a Pediatric Intensive Care Unit estimated by three instruments

ABSTRACT Objective: To compare the nursing workload using the Nursing Activities Score (NAS), Therapeutic Intervention Scoring System-28 (TISS-28) and Nine Equivalents of Nursing Manpower Use Score (NEMS) instruments in children admitted to a Pediatric Intensive Care Unit in a university hospital. Method: A prospective cohort study performed in a Pediatric Intensive Care Unit, with a sample formed of all children hospitalized during the study period. Nursing workload was evaluated using the TISS-28, NEMS and NAS instruments, and further divided into two groups: Group 1 forming a category of basic activities items and Group 2 forming a category of other support and intervention activities. Results: The sample consisted of 490 Pediatric Intensive Care Unit admissions, totaling 4617 observations. NAS presented the best estimate of total working hours. TISS-28 and NEMS showed better agreement and the results showed strong correlations between NAS and TISS-28 and between NEMS and TISS-28. In Group 1 (basic activities), NAS(1) and TISS-28(1) showed moderate correlation, in Group 2 (specialized activities) the three instruments showed strong correlations. Conclusion: NAS stood out in the evaluation of nursing workload and showed good correlation and agreement with the TISS-28.

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Scores TISS-28 versus NEMS to size the nursing team in a pediatric intensive care unit

Einstein (São Paulo) ◽

10.1590/s1679-45082017ao4028 ◽

2017 ◽

Vol 15 (4) ◽

pp. 470-475

Author(s):

Kelly Dayane Stochero Velozo ◽

Pedro Celiny Ramos Garcia ◽

Jefferson Pedro Piva ◽

Humberto Holmer Fiori ◽

Daiane Drescher Cabral ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Length Of Stay ◽

Prospective Study ◽

Pediatric Intensive Care Unit ◽

Pediatric Intensive Care ◽

Working Hours ◽

University Hospital ◽

Nursing Workload ◽

Nursing Team

ABSTRACT Objective: To estimate the workload and size the nursing team using the scales TISS-28 and NEMS in a pediatric intensive care unit. Methods: An observational prospective study with a quantitative approach was conducted at the pediatric intensive care unit of a university hospital from Jan 1st, 2009 to Dec 31st, 2009. All children who remained hospitalized for more than 8 hours were included, with length of stay of 4 hours in case of death. Clinical data were collected and the Paediatric Index of Mortality 2 and the scores TISS-28 and NEMS were determined. The TISS-28 and NEMS were converted into working hours of the nursing team and sizing complied with the parameters of the Brazilian Federal Nursing Council. Pearson's correlation and the Bland-Altman model were used to verify the association and agreement between the instruments. Results: A total of 459 children were included, totaling 3,409 observations. The average values for the TISS-28 and NEMS were 20.8±8 and 25.2±8.7 points, respectively. The nursing workload was 11 hours by TISS-28 and 13.3 hours by NEMS. The estimated number of professionals by TISS-28 and NEMS was 29.6 and 35.8 professionals, respectively. The TISS-28 and NEMS showed adequate correlation and agreement. Conclusion: Time spent in nursing activities and team sizing reflected by the NEMS were significantly greater when compared to the TISS-28.

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Estratégia Multidimensional na Redução de Infeção Associada a Cateter Venoso Central em Pediatria

Acta Médica Portuguesa ◽

10.20344/amp.5558 ◽

2016 ◽

Vol 29 (6) ◽

pp. 373

Author(s):

Jorge Rodrigues ◽

Andrea Dias ◽

Guiomar Oliveira ◽

José Farela Neves

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Central Venous Catheter ◽

Bloodstream Infection ◽

Pediatric Intensive Care Unit ◽

Pediatric Intensive Care ◽

Venous Catheter ◽

Central Line ◽

Central Venous ◽

Group 2

Introduction: To determine the central-line associated bloodstream infection rate after implementation of central venous catheter-care practice bundles and guidelines and to compare it with the previous central-line associated bloodstream infection rate. Material and Methods: A prospective, longitudinal, observational descriptive study with an exploratory component was performed in a Pediatric Intensive Care Unit during five months. The universe was composed of every child admitted to Pediatric Intensive Care Unit who inserted a central venous catheter. A comparative study with historical controls was performed to evaluate the result of the intervention (group 1 versus group 2). Results: Seventy five children were included, with a median age of 23 months: 22 (29.3%) newborns; 28 (37.3%) with recent surgery and 32 (43.8%) with underlying illness. A total of 105 central venous catheter were inserted, the majority a single central venous catheter (69.3%), with a mean duration of 6.8 ± 6.7 days. The most common type of central venous catheter was the short-term, non-tunneled central venous catheter (45.7%), while the subclavian and brachial flexure veins were the most frequent insertion sites (both 25.7%). There were no cases of central-line associated bloodstream infection reported during this study. Comparing with historical controls (group 1), both groups were similar regarding age, gender, department of origin and place of central venous catheter insertion. In the current study (group 2), the median length of stay was higher, while the mean duration of central venous catheter (excluding peripherally inserted central line) was similar in both groups. There were no statistical differences regarding central venous catheter caliber and number of lumens. Fewer children admitted to Pediatric Intensive Care Unit had central venous catheter inserted in group 2, with no significant difference between single or multiple central venous catheter. Discussion: After multidimensional strategy implementation there was no reported central-line associated bloodstream infection Conclusions: Efforts must be made to preserve the same degree of multidimensional prevention, in order to confirm the effective reduction of the central-line associated bloodstream infection rate and to allow its maintenance.

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Study of fungal infections in pediatric intensive care unit in Menoufiya University Hospital

Menoufia Medical Journal ◽

10.4103/1110-2098.132742 ◽

2014 ◽

Vol 27 (1) ◽

pp. 55

Author(s):

NagwanY. Saleh ◽

FadyM. ElGendy ◽

FahimaM. Hassan ◽

AhmedA. Khatab ◽

GhadaR. El-Hendawy

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Fungal Infections ◽

Pediatric Intensive Care ◽

University Hospital

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Efficacy and safety of dexmedetomidine for prevention of withdrawal syndrome in the pediatric intensive care unit: protocol for an adaptive, multicenter, randomized, double-blind, placebo-controlled, non-profit clinical trial

Trials ◽

10.1186/s13063-019-3793-6 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Maria Cristina Mondardini ◽

Francesca Sperotto ◽

Marco Daverio ◽

Fabio Caramelli ◽

Dario Gregori ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Withdrawal Syndrome ◽

Clinical Signs ◽

Pediatric Intensive Care ◽

University Hospital ◽

Prolonged Treatment ◽

Double Blind ◽

Double Blind Placebo

Abstract Background Prolonged treatment with analgesic and sedative drugs in the pediatric intensive care unit (PICU) may lead to undesirable effects such as dependence and tolerance. Moreover, during analgosedation weaning, patients may develop clinical signs of withdrawal, known as withdrawal syndrome (WS). Some studies indicate that dexmedetomidine, a selective α2-adrenoceptor agonist, may be useful to prevent WS, but no clear evidence supports these data. The aims of the present study are to evaluate the efficacy of dexmedetomidine in reducing the occurrence of WS during analgosedation weaning, and to clearly assess its safety. Methods We will perform an adaptive, multicenter, randomized, double-blind, placebo-controlled trial. Patients aged < 18 years receiving continuous intravenous analgosedation treatment for at least 5 days and presenting with clinical conditions that allow analgosedation weaning will be randomly assigned to treatment A (dexmedetomidine) or treatment B (placebo). The treatment will be started 24 h before the analgosedation weaning at 0.4 μg/kg/h, increased by 0.2 μg/kg/h per hour up to 0.8 μg/kg/h (neonate: 0.2 μg/kg/h, increased by 0.1 μg/kg/h per hour up to 0.4 μg/kg/h) and continued throughout the whole weaning time. The primary endpoint is the efficacy of the treatment, defined by the reduction in the WS rate among patients treated with dexmedetomidine compared with patients treated with placebo. Safety will be assessed by collecting any potentially related adverse event. The sample size assuring a power of 90% is 77 patients for each group (total N = 154 patients). The study was approved by the Ethics Committee of the University-Hospital S.Orsola-Malpighi of Bologna on 22 March 2017. Discussion The present trial will allow us to clearly assess the efficacy of dexmedetomidine in reducing the occurrence of WS during weaning from analgosedation drugs. In addition, the study will provide a unique insight into the safety profile of dexmedetomidine. Trial registration ClinicalTrials.gov, NCT03645603. Registered on 24 August 2018. EudraCT, 2015–002114-80. Retrospectively registered on 2 January 2019.

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Chlorhexidine-Impregnated Dressings and Prevention of Catheter-Associated Bloodstream Infections in a Pediatric Intensive Care Unit

Critical Care Nurse ◽

10.4037/ccn2016561 ◽

2016 ◽

Vol 36 (6) ◽

pp. e1-e7 ◽

Cited By ~ 5

Author(s):

Duygu Sönmez Düzkaya ◽

Nejla Canbulat Sahiner ◽

Gülzade Uysal ◽

Tülay Yakut ◽

Agop Çitak

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Pediatric Intensive Care ◽

Bloodstream Infections ◽

Standard Group ◽

Lengths Of Stay ◽

The Difference ◽

Group 2 ◽

Prolonged Hospital

Background Bloodstream infections related to use of catheters are associated with increased morbidity and mortality rates, prolonged hospital lengths of stay, and increased medical costs. Objectives To compare the effectiveness of chlorhexidine-impregnated dressings with that of standard dressings in preventing catheter-related bloodstream infections. Methods A total of 100 children were randomly divided into 2 groups of 50 each: a chlorhexidine group and a standard group. Patient care was provided in accordance with prevention bundles. Patients were followed up for development of catheter-related bloodstream infections. Results Catheter colonization occurred in 4 patients in the standard group (8%) and in 1 patient in the chlorhexidine group (2%). Catheter-related bloodstream infections occurred in 5 patients in the standard group (10%) and in 1 patient in the chlorhexidine group (2%). Although more patients in the standard group had catheter-related bloodstream infections, the difference in infection rates between the 2 groups was not significant (P = .07). Conclusions Use of chlorhexidine-impregnated dressings reduced rates of catheter-related bloodstream infections, contamination, colonization, and local catheter infection in a pediatric intensive care unit but was not significantly better than use of standard dressings.

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Efficacy and safety of Dexmedetomidine for prevention of withdrawal syndrome in Pediatric Intensive Care Unit: protocol for an adaptive, multicenter, randomized, double blind, placebo-controlled, non-profit clinical trial

10.21203/rs.2.491/v2 ◽

2019 ◽

Author(s):

Maria Cristina Mondardini ◽

Francesca Sperotto ◽

Marco Daverio ◽

Fabio Caramelli ◽

Dario Gregori ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Withdrawal Syndrome ◽

Clinical Signs ◽

Pediatric Intensive Care ◽

University Hospital ◽

Prolonged Treatment ◽

Double Blind ◽

Double Blind Placebo

Abstract Background: Prolonged treatment with analgesic and sedative drugs in Pediatric Intensive Care Unit (PICU) may lead to undesirable effects as dependence and tolerance. Moreover, during the analgosedation weaning patients may develop clinical signs of withdrawal, known as withdrawal syndrome (WS). Some studies indicated that dexmedetomidine, a selective α2-adrenoceptors agonist, may be useful to prevent WS, but no clear evidences support this data. Aims of the present study are to evaluate the efficacy of dexmedetomidine in reducing the occurrence of WS during the analgosedation weaning, and to clearly assess its safety. Methods: We will perform an adaptive, multicenter, randomized, double-blind, placebo-controlled trial. Patients <18 years receiving a continuous intravenous analgosedation treatment for at least 5 days and presenting with clinical conditions that allows the analgosedation weaning will be randomly assigned to treatment A (dexmedetomidine) or treatment B (placebo). The treatment will be started 24 hours before the analgosedation-weaning at 0.4 mcg/kg/h, increased of 0.2 mcg/kg/h per hour up to 0.8 mcg/Kg/h (neonate: 0.2 mcg/Kg/h, increased of 0.1 mcg/Kg/h per hour up to 0.4 mcg/Kg/h)and continued throughout the whole weaning-time. The primary endpoint is the efficacy of the treatment, defined by the reduction in WS rate among patients treated with dexmedetomidine comparing with patients treated with placebo. Safety will be assessed collecting any potentially-related adverse event. The sample size assuring a power of 90% is 77 patients for each group (N total=154 patients). The study was approved by the Ethics Committee of the University-Hospital S.Orsola-Malpighi of Bologna on 22 March 2017. Discussion: The present trial will allow to clearly assess the efficacy of dexmedetomidine in reducing the occurrence of WS during the weaning of analgosedation drugs. In addition, the study will provide a unique insight into the safety profile of dexmedetomidine. Trial registration: AIFA ID TIP-15-01.ClinicalTrials.govID NCT03645603, registered on 24 August 2018. Retrospectively registered on EudraCT with ID 2015-002114-80 on 2 Jan 2019.

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