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Fazio M, Jabbour E, Patel S, Bertelle V, Lapointe A, Lacroix G, Gravel S, Cabot M, Piedboeuf B, Beltempo M. Association of Shift-Level Organizational Factors with Nosocomial Infection in the Neonatal Intensive Care Unit. JOURNAL OF PEDIATRICS. CLINICAL PRACTICE 2024; 13:200112. [PMID: 38948384 PMCID: PMC11214522 DOI: 10.1016/j.jpedcp.2024.200112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 04/18/2024] [Accepted: 04/19/2024] [Indexed: 07/02/2024]
Abstract
Objective To evaluate the association between shift-level organizational data (unit occupancy, nursing overtime ratios [OTRs], and nursing provision ratios [NPRs]) with nosocomial infection (NI) among infants born very preterm in the neonatal intensive care unit (NICU). Study design This was a multicenter, retrospective cohort study, including 1921 infants 230/7-326/7 weeks of gestation admitted to 3 tertiary-level NICUs in Quebec between 2014 and 2018. Patient characteristics and outcomes (NIs) were obtained from the Canadian Neonatal Network database and linked to administrative data. For each shift, unit occupancy (occupied/total beds), OTR (nursing overtime hours/total nursing hours), and NPR (number of actual/number of recommended nurses) were calculated. Mixed-effect logistic regression models were used to calculate aOR for the association of organizational factors (mean over 3 days) with the risk of NI on the following day for each infant. Results Rate of NI was 11.5% (220/1921). Overall, median occupancy was 88.7% [IQR 81.0-94.6], OTR 4.4% [IQR 1.5-7.6], and NPR 101.1% [IQR 85.5-125.1]. A greater 3-day mean OTR was associated with greater odds of NI (aOR 1.08, 95% CI 1.02-1.15), a greater 3-day mean NPR was associated lower odds of NI (aOR 0.96, 95% CI 0.95-0.98), and occupancy was not associated with NI (aOR, 0.99, 95% CI 0.96-1.02). These findings were consistent across multiple sensitivity analyses. Conclusions Nursing overtime and nursing provision are associated with the adjusted odds of NI among infants born very preterm in the NICU. Further interventional research is needed to infer causality.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Quebec investigators of the Canadian Neonatal Network (CNN)∗
- McGill University, Montréal, QC, Canada
- Université de Sherbrooke, Sherbrooke, QC, Canada
- Université de Montréal, Montréal, QC, Canada
- Université Laval, Quebec, QC, Canada
- CHU Sainte-Justine, Montréal, QC, Canada
- CHU de Québec, Québec, QC, Canada
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Salazar EG, Passarella M, Formanowski B, Rogowski J, Edwards E, Phibbs C, Lorch SA. The Association of NICU Strain with Neonatal Mortality and Morbidity. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.07.07.24310050. [PMID: 39040203 PMCID: PMC11261945 DOI: 10.1101/2024.07.07.24310050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
Objective To examine the association of admission NICU strain with neonatal mortality and morbidity. Study Design 2008-2021 South Carolina cohort using linked vital statistics and discharge data of 22-44 weeks GA infants, born at hospitals with ≥ level 2 unit and ≥5 births of infants <34 weeks GA/year. The exposure was tertiles of admission NICU strain, defined as the sum of infants <44 weeks GA with a congenital anomaly plus all infants born <33 weeks GA at midnight on the day of birth. We used Poisson generalized linear mixed models to examine the association of exposure to strain with the primary outcome of a composite of mortality and term and preterm morbidities adjusting for patient and hospital characteristics. Results We studied 64,647 infants from 30 hospitals. High strain was associated with increased risk of mortality and morbidity adjusting for patient/hospital factors (aIRR 1.07, 95% CI 1.01 - 1.12). Conclusion NICU strain is associated with increased adverse outcomes.
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You W, Donnelly F. A cross-sectional study quantifies the independent contribution of nurses and midwives in child health outcomes. J Nurs Scholarsh 2024; 56:455-465. [PMID: 38108526 DOI: 10.1111/jnu.12951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 11/28/2023] [Accepted: 12/06/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION As the largest profession within the healthcare industry, nursing and midwifery workforce (NMW) provides comprehensive healthcare to children and their families. This study quantified the independent role of NMW in reducing under-5 mortality rate (U5MR) worldwide. DESIGN A retrospective, observational and correlational study to examine the independent role of NMW in protecting against U5MR. METHODS Within 266 "countries", the cross-sectional correlations between NMW and U5MR were examined with scatter plots, Pearson's r, nonparametric, partial correlation and multiple regression. The affluence, education and urban advantages were considered as the potential competing factors for the NMW-U5MR relationship. The NMW-U5MR correlations in both developing and developed countries were explored and compared. RESULTS Bivariate correlations revealed that NMW negatively and significantly correlated to U5MR worldwide. When the contributing effects of economic affluence, urbanization and education were removed, the independent NMW role in reducing U5MR remained significant. NMW independently explained 9.36% U5MR variance. Multilinear regression selected NMW as a significant factor contributing an extra 3% of explanation to U5MR variance when NMW, affluence, education and urban advantage were incorporated as the predicting variables. NMW correlated with U5MR significantly more strongly in developing countries than in developed countries. CONCLUSION NMW, indexing nursing and midwifery service, was a significant factor for reducing U5MR worldwide. This beneficial effect explained 9.36% of U5MR variance which was independent of economic affluence, urbanization and education. The NMW may be a more significant risk factor for protecting children from dying under 5 years old in developing countries. As a strategic response to the advocacy of the United Nations to reduce child mortality, it is worthy for health authorities to consider a further extension of nurses and midwives' practice scope to enable communities to have more access to NMW healthcare services.
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Affiliation(s)
- Wenpeng You
- Adelaide Nursing School, The University of Adelaide, Adelaide, South Australia, Australia
- Heart and Lung, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Cardiology & Respiratory, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Frank Donnelly
- Adelaide Nursing School, The University of Adelaide, Adelaide, South Australia, Australia
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Beltempo M, Bresson G, Lacroix G. Using machine learning to predict nosocomial infections and medical accidents in a NICU. HEALTH AND TECHNOLOGY 2023. [DOI: 10.1007/s12553-022-00723-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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5
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Neonatal intensive care unit occupancy rate and probability of discharge of very preterm infants. J Perinatol 2023; 43:490-495. [PMID: 36609482 DOI: 10.1038/s41372-022-01596-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/05/2022] [Accepted: 12/22/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To assess the association of NICU occupancy with probability of discharge and length of stay (LOS) among infants born <33 weeks gestational age (GA). STUDY DESIGN Retrospective study of 3388 infants born 23-32 weeks GA, admitted to five Level 3/4 NICUs (2014-2018) and discharged alive. Standardized ratios of observed-to-expected number of discharges were calculated for each quintile of unit occupancy. Multivariable linear regression models were used to assess the association between occupancy and LOS. RESULTS At the lowest unit occupancy quintiles (Q1 and Q2), infants were 12% and 11% less likely to be discharged compared to the expected number. At the highest unit occupancy quintile (Q5), infants were 20% more likely to be discharged. Highest occupancy (Q5) was also associated with a 4.7-day (95% CI 1.7, 7.7) reduction in LOS compared Q1. CONCLUSION NICU occupancy was associated with likelihood of discharge and LOS among infants born <33 weeks GA.
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Tomo CK, Balogun OO, Davidson J, Guinsburg R, Almeida MFBD, Lopes JMDA, Barros MCDM, Takehara K, Mikami M, Isayama T, Hoshino A, Mori R, Mizuguchi M. Comparison of mortality and survival without major morbidities of very preterm infants with very low birth weight from Japan and Brazil. REVISTA PAULISTA DE PEDIATRIA 2023; 41:e2021389. [PMID: 36102406 PMCID: PMC9462411 DOI: 10.1590/1984-0462/2023/41/2021389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/13/2022] [Indexed: 11/22/2022]
Abstract
Objective: This study was carried out to understand the disparities in mortality and survival without major morbidities among very premature and very low birth weight infants between participating Neonatal Intensive Care Units (NICUs) from the Brazilian Network on Neonatal Research (RBPN) and the Neonatal Research Network of Japan (NRNJ). Methods: Secondary data analysis of surveys by the RBPN and NRNJ was performed. The surveys were conducted in 2014 and 2015 and included 187 NICUs. Primary outcome was mortality or survival without any major morbidity. Logistic regression analysis adjustment for confounding factors was used. Results: The study population consisted of 6,406 infants from the NRNJ and 2,319 from the RBPN. Controlling for various confounders, infants from RBPN had 9.06 times higher adjusted odds of mortality (95%CI 7.30–11.29), and lower odds of survival without major morbidities (AOR 0.36; 95%CI 0.32–0.41) compared with those from the NRNJ. Factors associated with higher odds of mortality among Brazilian NICUs included: Air Leak Syndrome (AOR 4.73; 95%CI 1.26–15.27), Necrotizing Enterocolitis (AOR 3.25; 95%CI 1.38–7.26), and Late Onset Sepsis (LOS) (AOR 4.86; 95%CI 2.25–10.97). Conclusions: Very premature and very low birth weight infants from Brazil had significantly higher odds for mortality and lower odds for survival without major morbidities in comparison to those from Japan. Additionally, we identified the factors that increased the odds of in-hospital neonatal death in Brazil, most of which was related to LOS.
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Affiliation(s)
- Caroline Kaori Tomo
- University of Tokyo, Japan; National Center for Child Health and Development, Japan
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Ohnstad MO, Stensvold HJ, Pripp AH, Tvedt CR, Jelsness-Jørgensen LP, Astrup H, Eriksen BH, Lunnay ML, Mreihil K, Pedersen T, Rettedal SI, Selberg TR, Solberg R, Støen R, Rønnestad AE. Associations between unit workloads and outcomes of first extubation attempts in extremely premature infants below a gestational age of 26 weeks. Front Pediatr 2023; 11:1090701. [PMID: 37009293 PMCID: PMC10064049 DOI: 10.3389/fped.2023.1090701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 02/27/2023] [Indexed: 04/04/2023] Open
Abstract
Objective The objective was to explore whether high workloads in neonatal intensive care units were associated with short-term respiratory outcomes of extremely premature (EP) infants born <26 weeks of gestational age. Methods This was a population-based study using data from the Norwegian Neonatal Network supplemented by data extracted from the medical records of EP infants <26 weeks GA born from 2013 to 2018. To describe the unit workloads, measurements of daily patient volume and unit acuity at each NICU were used. The effect of weekend and summer holiday was also explored. Results We analyzed 316 first planned extubation attempts. There were no associations between unit workloads and the duration of mechanical ventilation until each infant's first extubation or the outcomes of these attempts. Additionally, there were no weekend or summer holiday effects on the outcomes explored. Workloads did not affect the causes of reintubation for infants who failed their first extubation attempt. Conclusion Our finding that there was no association between the organizational factors explored and short-term respiratory outcomes can be interpreted as indicating resilience in Norwegian neonatal intensive care units.
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Affiliation(s)
- Mari Oma Ohnstad
- Department of Master and Postgraduate Education, Lovisenberg Diaconal University College, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Hans Jørgen Stensvold
- Department of Neonatal Intensive Care, Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo, Norway
- Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Christine Raaen Tvedt
- Department of Master and Postgraduate Education, Lovisenberg Diaconal University College, Oslo, Norway
| | - Lars-Petter Jelsness-Jørgensen
- Department of Master and Postgraduate Education, Lovisenberg Diaconal University College, Oslo, Norway
- Department of Health and Welfare, Østfold University College, Halden, Norway
- Department of Internal Medicine, Østfold Hospital Trust, Kalnes, Norway
| | - Henriette Astrup
- Department of Pediatric and Adolescent Medicine, Sorlandet Hospital Trust, Kristiansand, Norway
| | - Beate Horsberg Eriksen
- Department of Pediatrics, Møre and Romsdal Hospital Trust, Ålesund, Norway
- Clinical Research Unit, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mai Linn Lunnay
- Department of Pediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Khalaf Mreihil
- Department of Pediatrics and Adolescence Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Tanja Pedersen
- Neonatal Intensive Care Unit, Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Siren Irene Rettedal
- Department of Pediatrics, Stavanger University Hospital, Stavanger, Norway
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Terje Reidar Selberg
- Department of Pediatrics and Adolescence Medicine, Østfold Hospital Trust, Kalnes, Norway
| | - Rønnaug Solberg
- Department of Pediatrics, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Pediatric Research, Oslo University Hospital, Oslo, Norway
| | - Ragnhild Støen
- Department of Neonatology, St Olavs - Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arild Erland Rønnestad
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Neonatal Intensive Care, Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- Research Group for Clinical Neonatal Medicine and Epidemiology, Department of Neonatal Intensive Care, Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
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Singh S, Scott W, Yeager C, Rambaran M, Singh NC, Nelin LD. Implementation of a Level III neonatal intensive care unit was associated with reduced NICU mortality in a resource limited public tertiary care hospital in Guyana, South America. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000651. [PMID: 36962726 PMCID: PMC10021212 DOI: 10.1371/journal.pgph.0000651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 01/20/2023] [Indexed: 02/17/2023]
Abstract
Neonatal mortality is a significant contributor to child mortality, and there is increasing interest in low resource settings to implement neonatal intensive care practices to lower neonatal mortality. In Guyana, South America neonatal mortality remains relatively high. At Georgetown Public Hospital Corporation (GPHC), the only tertiary referral hospital in Guyana, a Level III NICU was developed starting in January, 2012 with full implementation in September, 2015. In this study, we report the association of the implementation of a Level III NICU with in-hospital neonatal survival at GPHC. Using an observational study design, available data were collected from January 1, 2015 through September 30, 2020. During the study period, there were 30,733 deliveries at GPHC and 4,467 admissions to the NICU at GPHC. There were no significant changes in the numbers of births or NICU admissions during the time of the study. The survival rate for patients admitted to the NICU was ~64% during the first 3 quarters of 2015 with most deaths were caused by sepsis or respiratory failure. By the last quarter of 2015, the NICU survival rate increased dramatically and has been sustained at ~87% (p<0.0001). The inborn mortality rate at GPHC, calculated as a percentage of all live births at GPHC, was 2.9% prior to the full implementation of the NICU and was 1.4% after the full implementation of the NICU (p<0.0001). These findings suggest that the implementation of a Level III NICU at GPHC was associated with an improvement in survival to NICU discharge in a resource limited setting.
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Affiliation(s)
- Sara Singh
- Paediatrics, Georgetown Public Hospital Corporation, Georgetown, Guyana
- Institute for Health Sciences Education, Georgetown, Guyana
| | - Winsome Scott
- Paediatrics, Georgetown Public Hospital Corporation, Georgetown, Guyana
- Institute for Health Sciences Education, Georgetown, Guyana
| | - Caitlin Yeager
- Guyana Help the Kids, Toronto, ON, Canada
- Breen School of Nursing and Health Professions, Ursuline College, Pepper Pike, OH, United States of America
| | - Madan Rambaran
- Paediatrics, Georgetown Public Hospital Corporation, Georgetown, Guyana
- Institute for Health Sciences Education, Georgetown, Guyana
| | | | - Leif D Nelin
- Guyana Help the Kids, Toronto, ON, Canada
- Division of Neonatology, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, United States of America
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Dall'Ora C, Saville C, Rubbo B, Turner L, Jones J, Griffiths P. Nurse staffing levels and patient outcomes: A systematic review of longitudinal studies. Int J Nurs Stud 2022; 134:104311. [DOI: 10.1016/j.ijnurstu.2022.104311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/04/2022] [Accepted: 06/09/2022] [Indexed: 02/08/2023]
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Le Blanc G, Jabbour E, Patel S, Kazantseva O, Zeid M, Olivier F, Shalish W, Beltempo M. Organizational Risk Factors and Clinical Impacts of Unplanned Extubation in the Neonatal Intensive Care Unit. J Pediatr 2022; 249:14-21.e5. [PMID: 35714965 DOI: 10.1016/j.jpeds.2022.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/31/2022] [Accepted: 06/09/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To assess the association between organizational factors and unplanned extubation events in the neonatal intensive care unit (NICU) and to evaluate the association between unplanned extubation event and bronchopulmonary dysplasia (BPD) among infants born at <29 weeks of gestational age. STUDY DESIGN This is a retrospective cohort study of infants admitted to a tertiary care NICU between 2016 and 2019. Nursing provision ratios, daily nursing overtime hours/total nursing hours ratio, and unit occupancy were compared between days with and days without unplanned extubation events. The association between unplanned extubation events (with and without reintubation) and the risk of BPD was evaluated in infants born at <29 weeks who required mechanical ventilation using a propensity score-matched cohort. Multivariable logistic regression analysis was used to assess the association between exposures and outcomes while adjusting for confounders. RESULTS On 108 of 1370 days there was ≥1 unplanned extubation event for a total of 116 unplanned extubation event events. Higher median nursing overtime hours (20 hours vs 16 hours) and overtime ratios (3.3% vs 2.5%) were observed on days with an unplanned extubation event compared with days without an unplanned extubation event (P = .01). Overtime ratio was associated with higher adjusted odds of a unplanned extubation event (aOR, 1.09; 95% CI, 1.01-1.18). In the subgroup of infants born at <29 weeks, those with an unplanned extubation event who were reintubated had a longer postmatching duration of mechanical ventilation (aOR, 13.06; 95% CI, 4.88-37.69) and odds of BPD (aOR, 2.86; 95% CI, 1.01-8.58) compared with those without an unplanned extubation event. CONCLUSIONS Nursing overtime ratio is associated with an increased number of unplanned extubation events in the NICU. In infants born at <29 weeks of gestational age, reintubation after an unplanned extubation event is associated with a longer duration of mechanical ventilation and increased risk of BPD.
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Affiliation(s)
| | - Elias Jabbour
- McGill University Health Center Research Institute, Montreal, Quebec, Canada
| | - Sharina Patel
- McGill University Health Center Research Institute, Montreal, Quebec, Canada
| | - Olga Kazantseva
- Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Marco Zeid
- Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Francois Olivier
- Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Wissam Shalish
- Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Marc Beltempo
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada; McGill University Health Center Research Institute, Montreal, Quebec, Canada; Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada.
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Abstract
ABSTRACT The challenge of nurse staffing is amplified in the acute care neonatal intensive care unit (NICU) setting, where a wide range of highly variable factors affect staffing. A comprehensive overview of infant factors (severity, intensity), nurse factors (education, experience, preferences, team dynamics), and unit factors (structure, layout, shift length, care model) influencing pre-shift NICU staffing is presented, along with how intra-shift variability of these and other factors must be accounted for to maintain effective and efficient assignments. There is opportunity to improve workload estimations and acuity measures for pre-shift staffing using technology and predictive analytics. Nurse staffing decisions affected by intra-shift factor variability can be enhanced using novel care models that decentralize decision-making. Improving NICU staffing requires a deliberate, systematic, data-driven approach, with commitment from nurses, resources from the management team, and an institutional culture prioritizing patient safety.
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Standards for Professional Registered Nurse Staffing for Perinatal Units. Nurs Womens Health 2022; 26:e1-e94. [PMID: 35750618 DOI: 10.1016/j.nwh.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Standards for Professional Registered Nurse Staffing for Perinatal Units. J Obstet Gynecol Neonatal Nurs 2022; 51:e5-e98. [PMID: 35738987 DOI: 10.1016/j.jogn.2022.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Lemieux-Bourque C, Piedboeuf B, Gignac S, Taylor-Ducharme S, Julien AS, Beltempo M. Comparison of Three Nursing Workload Assessment Tools in the Neonatal Intensive Care Unit and Their Association with Outcomes of Very Preterm Infants. Am J Perinatol 2022; 39:640-645. [PMID: 33053592 DOI: 10.1055/s-0040-1718571] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Nursing workload assessment tools are widely used to determine nurse staffing requirements in the neonatal intensive care unit (NICU). We aimed to compare three existing workload assessment tools and assess their association with mortality or morbidity among very preterm infants. STUDY DESIGN Single-center retrospective cohort study of infants born <33 weeks and admitted to a 52-bed tertiary NICU in 2017 to 2018. Required nurse staffing was estimated for each shift using the Winnipeg Assessment of Neonatal Nursing Needs Tool (WANNNT) used as reference tool, the Quebec Provincial NICU Nursing Ratio (QPNNR), and the Canadian NICU Resource Utilization (CNRU). Poisson regression models with robust error variance estimators were used to assess the association between nursing provision ratios (actual number of nurses/required number of nurses) during the first 7 days of admission and neonatal outcomes. RESULTS Median number of nurses required per shift using the WANNNT was 25.0 (interquartile range [IQR]: 23.1-26.7). Correlation between WANNNT and QPNNR was high (r = 0.92, p < 0.0001), but the QPNNR underestimated the number of nurses per shift by 4.8 (IQR: 4.1-5.4). Correlation between WANNNT and CNRU was moderate (r = 0.45, p < 0.0001). The NICU nursing provision ratios during the first 7 days of admission calculated using the WANNNT (adjusted risk ratio [aRR]: 0.96, 95% confidence interval [CI]: 0.93-0.99) and QPNNR (aRR: 0.97, 95% CI: 0.95-0.99) were associated with mortality or morbidity. CONCLUSION Lower nursing provision ratio calculated using the WANNNT and CNRU during the first 7 days of admission is associated with an increased risk of mortality/morbidity in very preterm infants. KEY POINTS · NICUs use different nursing workload assessment tools.. · We validated three different nursing workload assessment tools used in the NICU.. · Nursing provision ratio is associated the risk of mortality/morbidity in preterm infants..
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Affiliation(s)
- Charlotte Lemieux-Bourque
- CHU de Québec Research Center, Quebec, Canada.,Department of Pediatrics, Faculty of Medicine, Université Laval, Quebec, Canada
| | - Bruno Piedboeuf
- CHU de Québec Research Center, Quebec, Canada.,Department of Pediatrics, Faculty of Medicine, Université Laval, Quebec, Canada
| | - Simon Gignac
- Neonatal Intensive Care Unit, Montreal Children's Hospital, Montreal, Quebec, Canada
| | | | - Anne-Sophie Julien
- Statistical Consulting Service, Department of Mathematics and Statistics, Université Laval, Quebec, Canada
| | - Marc Beltempo
- Division of Neonatology, Department of Pediatrics, McGill University, Montreal, Quebec, Canada.,McGill University Health Centre Research Institute, Montreal, Quebec, Canada
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Rizzolo A, Shah PS, Bertelle V, Makary H, Ye XY, Abenhaim HA, Piedboeuf B, Beltempo M. Association of timing of birth with mortality among preterm infants born in Canada. J Perinatol 2021; 41:2597-2606. [PMID: 34050244 DOI: 10.1038/s41372-021-01092-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/31/2021] [Accepted: 04/30/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess the association between time of birth and mortality among preterm infants. STUDY DESIGN Population-based study of infants born 22-36 weeks gestation (GA) in Canada from 2010 to 2015 (n = 173 789). Multivariable logistic regression models assessed associations between timing of birth and mortality. RESULT Among infants 22-27 weeks GA, evening birth was associated with higher mortality than daytime birth (adjusted odds ratio [AOR] 1.14, 95% CI 1.01-1.29). Among infants 28-32 weeks GA and 33-36 weeks GA, night birth was associated with lower mortality than daytime birth (AOR 0.75, 95% CI 0.59-0.95; AOR 0.78, 95% CI 0.62-0.99, respectively). Sensitivity analysis excluding infants with major congenital anomaly revealed that associations between hour of birth and mortality among infants born 28-32 and 33-36 weeks GA decreased or were not statistically significant. CONCLUSION Higher mortality among extremely preterm infants during off-peak hours may suggest variations in available resources based on time of day.
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Affiliation(s)
- Angelo Rizzolo
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Prakesh S Shah
- Departments of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, ON, Canada
| | - Valerie Bertelle
- Department of Pediatrics, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Hala Makary
- Department of Pediatrics, Dr. Everett Chalmers Hospital, Fredericton, NB, Canada
| | - Xiang Y Ye
- Maternal-infant Care Research Centre, Mount Sinai Hospital, Toronto, ON, Canada
| | - Haim A Abenhaim
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Bruno Piedboeuf
- Department of Pediatrics, Université Laval, Quebec, QC, Canada
| | - Marc Beltempo
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada.
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Bae SH. Relationships between comprehensive characteristics of nurse work schedules and adverse patient outcomes: A systematic literature review. J Clin Nurs 2021; 30:2202-2221. [PMID: 33616252 DOI: 10.1111/jocn.15728] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 02/05/2021] [Accepted: 02/12/2021] [Indexed: 11/29/2022]
Abstract
AIMS To review the comprehensive characteristics of adverse nurse work schedules and to synthesise the evidence of their relationships with adverse patient outcomes. BACKGROUND To manage nurse shortages and fluctuations in patient censuses, nurses often work overtime. This increases nurses' work hours and causes them to have fewer breaks. Such extended work schedules, long shift length, long weekly work hours and insufficient beaks can be considered as adverse nurse work schedules. Understanding how these adverse nurse work schedules affect patient outcomes is important to ensure patient safety. DESIGN A systematic review of nursing and healthcare literature was conducted in this study. METHODS Eight electronic bibliographic databases (CINAHL, Cochrane Library, DBpia, EBSCO, PubMed, PsycINFO, RISS and Web of Science) were used to search research articles published from 2000 to 2019. The study selection process followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). RESULTS From the search, 2,366 articles were identified, 22 of which were included in this review. Working more than 12 hours in a day had an adverse effect on patient outcomes, as was working more than 40 hours per week. There were mixed findings in the relationship between nurse overtime and adverse patient outcomes. CONCLUSIONS This study found a conclusive relationship between excessive nurse work hours and adverse patient outcomes. This review highlights the importance of managing adverse nurse schedules such as long daily and weekly work hours to improve patient safety and prevent adverse patient outcomes. RELEVANCE TO CLINICAL PRACTICE Study findings support the importance of monitoring and regulating nurse work schedules and adverse scheduling practices to improve nurse well-being and health and to prevent adverse patient outcomes.
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Affiliation(s)
- Sung-Heui Bae
- College of Nursing, Graduate Program in System Health Science and Engineering (BK 21), Ewha Womans University, Seoul, Republic of Korea
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Stokes-Parish J, Elliott R, Rolls K, Massey D. Angels and Heroes: The Unintended Consequence of the Hero Narrative. J Nurs Scholarsh 2020; 52:462-466. [PMID: 32856396 PMCID: PMC7461164 DOI: 10.1111/jnu.12591] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2020] [Indexed: 01/30/2023]
Affiliation(s)
- Jessica Stokes-Parish
- John Hunter Hospital, Hunter New England Health Local Health District, Hunter Medical Research Institute, New South Wales, Australia
| | - Rosalind Elliott
- Translational Research Coordinator, NSLHD Nursing and Midwifery Directorate, and Clinical Nurse Specialist, The Malcolm Fisher Intensive Care Unit, Royal North Shore Hospital, Northern Sydney Local Health District, New South Wales, Australia
| | - Kaye Rolls
- Lecturer, University of Wollongong, New South Wales, Australia
| | - Debbie Massey
- Associate Professor, RN, PhD, School of Health and Human Sciences, Southern Cross University, Queensland, Australia
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Successful Reduction in Electrode-Related Pressure Ulcers During EEG Monitoring in Critically Ill Neonates. Adv Neonatal Care 2019; 19:262-274. [PMID: 31335377 DOI: 10.1097/anc.0000000000000641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Neonates are at a high risk for pressure ulcers (PU) due to skin immaturity and exposure to various medical devices. The prevalence of PU in the neonatal intensive care unit is estimated to be 23%, with 80% of those being related to medical devices, including electroencephalographic (EEG) electrodes. Proposed mechanisms involve prolonged pressure to the electrodes and chemical reactions to conductive agents. PURPOSE The object of this quality improvement project was to reduce PU in neonates during continuous EEG (cEEG) monitoring by 50% within 12 months and 75% within 18 months. A secondary objective was to eliminate electrode-related infections by 12 months. Balancing measures included gestational age at the time of monitoring, integrity of the EEG setup, and cost effectiveness. The process measure was adherence to the skin-monitoring tool kit. METHODS A multiple Plan-Do-Study-Act cycle method was used. All neonates monitored with cEEG were included. The monitoring tool kit was used to document the condition of scalp and EEG electrodes before, during, and after cEEG. RESULTS In the preproject period, 8.5% (9/106) of monitored patients developed PU, and 22.2% (2/9) of those developed infections. During the project period, 3.5% (7/198) of monitored patients developed PU and no infections were observed. During monitoring, 21 patients showed skin irritation, and timely intervention resulted in resolution in more than 90% of the cases and prevented progression into PU. Silver/silver chloride-plated electrodes, when exposed to external heat sources, can cause burns, resembling PU. IMPLICATIONS FOR PRACTICE Intervention at the electrode level together with skin inspection successfully reduces PU in neonates. Silver/silver chloride-plated electrodes should be avoided in neonates. IMPLICATIONS FOR RESEARCH Further research is needed to identify the optimal electrode for neonatal EEG.
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