Propuesta de una nueva escala de valoración de cargas de trabajo y tiempos de enfermería (VACTE©)

Adecuación de escalas para medir cargas de trabajo mediante metodología de calidad

RESUMEN Objetivo: Determinar cuál de las escalas evaluadas (NEMS y NAS), es más adecuada para Unidades de Cuidados Intensivos aplicando metodología de calidad. Método: Tras identificar como oportunidad de mejora la no adecuación de la escala NEMS para determinar cargas de trabajo de enfermería en UCI, se aplica metodología de los ciclos de mejora a dicha escala y a la NAS, como propuesta de mejora, evaluando los criterios: medición de cargas de trabajo al día y por turno, inclusión de todas las actividades enfermeras, y análisis por paciente y unidad. Resultados: Escala NEMS no muestra diferencias significativas en el cumplimiento (67%). Comparación NEMS-NAS, todos los criterios excepto el 1º, obtienen mejora significativa. NEMS sólo valora el criterio 1 (64,22%), y NAS todos con un cumplimiento para el 1º, 2º y 4º del 64,74%, y el 3º del 100%. Conclusión: La escala NAS es más adecuada para medir cargas de trabajo de enfermería en UCI.

[Analysis of the workload and the use of the nursing resources in an intensive care unit]

OBJECTIVE

To evaluate and assess the nursing workload (NW) scales by means of three scales and to determine the theoretical and real nurse/patient relationship in a polyvalent ICU.

METHODOLOGY

Cross-sectional descriptive study between July 2012 and June 2013 in patients over 18 years old, for which 3 nurses quantified, in randomized days, the NW by the Nursing Activities Score (NAS), Nine Equivalents Manpower Score (NEMS) and Valoración de Cargas de Trabajo y Tiempos de Enfermería (VACTE). Efficiency parameters of nursing resources were calculated: "work utilization ratio" (WUR), "level of care" operative (LOCop) and planned (LOCp). Data on demographics, length of stay and number of nurses were collected.

RESULTS

720 records were collected. The mean age was 64 (13.6) years. 73% were male and the median of length of stay was 3 (1-12) days. 60% were admitted for medical causes. The average total score was: NAS: 696.8 (111.6), NEMS: 311.8 (55.3) and VACTE: 4,978 (897.7). The required number of nurses according to NAS was 7 and 6,7 according to NEMS and VACTE. The actual average was 5.5. On all 3 scales the WUR was >1 and LOCop was 1.6 pacients/nurse. The LOCp was 2 patients/nurse.

CONCLUSION

Assessing NW allows to know the reality of each unit. According to the scales and efficiency parameters of the nursing resources used, there is a shortage of nurses in relation to the work generated. NAS reflects more parameters of NW.

[NEMS: a new predictor of mortality in the critical patient?]

Numerical scales are commonly used in intensive care units to predict hospital mortality and to assess the therapeutic effort and care that critically ill patients require. The aim of this work was to study whether the NEMS value can be used as a predictor of mortality, comparing it with the APACHE II. A prospective study in a 24 intensive care unit beds was conducted. The APACHE II and NEMS values were stratified into three levels. Demographic data and the first 24 hours values of APACHE II and NEMS scales were collected. A total of 1257 patients were included, 16.4% of whom died. 69.6% were surgical; median stay was 2 days (1-4). Median age was 66 years (50-77), 59.3% were men. The median APACHE II and NEMS for the living and the dead in the subsequent course was 10 (6-20) versus 22.5 (17.25 to 29) (p <0.001) and 24 (18-29) versus 34 (25 to 39.7) (p<0.001) respectively. The correlation between both scales was rho=0.457 (p<0.01). Logistic regression controlled for age, sex and APACHE II showed an OR of 3.1 (95% CI: 1.5-6.6) only for high NEMS, compared to the lowest level. According to the results NEMS should not be used as a predictor of mortality, although the risk of death increases by three times with high NEMS.