Paul Ross, Carol L Hodgson, Dragan Ilic, Jason Watterson, Emily Gowland, Kathleen Collins, Tim Powers, Andrew Udy, David Pilcher
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Intensive care is considered a high-risk area for errors and adverse events (AE) due to the severity of illness and number of procedures performed.</p><p><strong>Objective: </strong>To investigate if the percentage of Critical Care Registered Nurses (CCRN) within an Intensive Care Unit (ICU) is associated with an increased risk of patients experiencing an AE.</p><p><strong>Design & setting: </strong>We conducted a retrospective cohort study of patients admitted between January 2016 and December 2020 to a tertiary ICU in Australia. Descriptive statistics and multivariable logistic regression were used to investigate the relationship between the proportion of CCRNs each month and the occurrence of an AE defined as any one of a medication error, fall, pressure injury or unplanned removal of a central venous catheter or endotracheal tube per patient.</p><p><strong>Results: </strong>A total of 13,560 patients were included in the study, with 854 (6.3%) experiencing one AE. 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引用次数: 0
摘要
背景:重症监护的高度复杂和技术环境管理着医院系统中最严重的不适患者，因此需要一支训练有素的护理队伍。由于疾病的严重程度和手术的数量，重症监护被认为是错误和不良事件(AE)的高风险领域。目的:调查重症监护病房(ICU)重症监护注册护士(CCRN)的比例是否与患者发生AE的风险增加有关。设计与环境:我们对2016年1月至2020年12月在澳大利亚三级ICU住院的患者进行了回顾性队列研究。采用描述性统计和多变量logistic回归研究每月ccrn的比例与AE的发生之间的关系，AE定义为每个患者用药错误、跌倒、压伤或意外拔出中心静脉导管或气管内管中的任何一种。结果:研究共纳入13560例患者，其中854例(6.3%)发生一次AE。AE患者与较高的疾病严重程度和虚弱评分相关。他们更常在医疗急救小组响应电话后入院，而不太常见的是选择性ICU入院。平均而言，AE患者的ICU和住院时间较长，ICU和住院死亡率较高。在调整ICU LOS和急性疾病严重程度后，在重症监护护理技能组合较高的一个月内入院与随后发生AE的几率较低相关(OR 0.966 [95% CI: 0.944-0.988]， p 0.003)。结论:ccrn百分比的增加与较低的AE风险调整可能性独立相关。增加ICU护理人员的技能组合可以减少ae的发生并改善患者的预后。
The impact of nursing skill-mix on adverse events in intensive care: a single centre cohort study.
Background: The highly complex and technological environment of critical care manages the most critically unwell patients in the hospital system, as such there is a need for a highly trained nursing workforce. Intensive care is considered a high-risk area for errors and adverse events (AE) due to the severity of illness and number of procedures performed.
Objective: To investigate if the percentage of Critical Care Registered Nurses (CCRN) within an Intensive Care Unit (ICU) is associated with an increased risk of patients experiencing an AE.
Design & setting: We conducted a retrospective cohort study of patients admitted between January 2016 and December 2020 to a tertiary ICU in Australia. Descriptive statistics and multivariable logistic regression were used to investigate the relationship between the proportion of CCRNs each month and the occurrence of an AE defined as any one of a medication error, fall, pressure injury or unplanned removal of a central venous catheter or endotracheal tube per patient.
Results: A total of 13,560 patients were included in the study, with 854 (6.3%) experiencing one AE. Patients with an AE were associated with higher illness severity and frailty scores. They were more commonly admitted after medical emergency team response calls and were less commonly elective ICU admissions. Those with an AE had longer ICU and in-hospital length of stay, and higher ICU and in-hospital mortality, on average. After adjusting for ICU LOS and acute severity of illness, being admitted during a month of higher critical care nursing skill-mix was associated with a statistically significant lower odds of having a subsequent AE (OR 0.966 [95% CI: 0.944-0.988], p 0.003).
Conclusion: An increasing percentage of CCRNs is independently associated with a lower risk-adjusted likelihood of an AE. Increasing the skill-mix of the ICU nursing staff may reduce the occurrence of AEs and lead to improved patient outcomes.
期刊介绍：
Contemporary Nurse is an international peer-reviewed journal designed to increase nursing skills, knowledge and communication, assist in professional development and to enhance educational standards by publishing stimulating, informative and useful articles on a range of issues influencing professional nursing research, teaching and practice.
Contemporary Nurse is a forum for nursing educators, researchers and professionals who require high-quality, peer-reviewed research on emerging research fronts, perspectives and protocols, community and family health, cross-cultural research, recruitment, retention, education, training and practitioner perspectives.
Contemporary Nurse publishes original research articles, reviews and discussion papers.
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