Nursing quality indicators for adult intensive care: A consensus study

Incidence of unscheduled removal of invasive devices in patients with COVID-19 in intensive care

INTRODUCTION

The rate of unscheduled removal of invasive devices (ID) is an indicator of quality programmes in the critically ill. Our research group performed prevalence analyses since 2010 and another during the pandemic. The aim was to analyse the rates of use and non-planed removal of endotracheal tubes, catheters (central venous and arterial) and enteral catheters in the first wave of the COVID-19 pandemic comparing them with previous rates.

METHODOLOGY

Prevalence study in a polyvalente ICU. After 4 prospective observational analyses (2010, 2011, 2018, 2019) a retrospective analysis was performed (8 March-8 May 2020).

VARIABLES

diagnosis, stay and reason for removal of ID (endotracheal tubes (ET), central venous catheters, arterial catheters and enteral catheters) and rate of reintubation after self-removal of ET. Variables analysed and described as accidental removal rates per 1000 device-days and rates of ID use.

RESULTS

2026 patients were included (631 in 2010, 724 in 2011, 210 in 2018, 361 in 2019 and 100 in 2020). Significant differences, between all periods, in diagnoses (p < 0.001), ICU stay (p < 0.001) and mortality (p = 0.016) and, between 2020 and all other periods, in rates of use per 100 days-stay (p < 0.010) and per 100 admissions (p < 0.001) in all devices except arterial catheter. In 2020, there was an increase in ET obstruction (36.0%; rate 20.27 per 1000 intubation-days, p < 0.010), decrease in ET self-removals (2020 rate: 0.00 per 1000 intubation-days; p < 0.050) and enteral catheters (14.33 per 1000 catheter-days). Overall reintubation (all periods) after self-extubation: 12.5%.

CONCLUSIONS

The rate of devices self-removal in COVID-19 patients in the first wave of the pandemic was lower than that observed in the previous four periods. The high incidence rate of ET obstruction in these patients was significant and relevant.

The identification and characterization of nurse-sensitive outcomes in acute and critical care: A systematic review

BACKGROUND

Few nurse-sensitive patient and family outcome measures are included in hospital core metrics used for accreditation, credentialing, or recognition.

PURPOSE

Identify and characterize patient and family outcome measures that are sensitive to the work of acute and critical nursing.

METHODS

Systematic literature review that included all age groups and excluded measures commonly reported for hospital accreditation, credentialing, or recognition (i.e., patient falls, pressure injuries/pressure ulcers, and hospital-acquired infections).

DISCUSSION

In total, 16 studies met review criteria. Eight (50%) studies were conducted in acute care, five (31.3%) in critical care, and three (18.8%) in surgical settings. Eight (50%) were conducted in adults, four (25%) in pediatrics, and one (6.3%) in neonates. Three (18.8%) studies did not specify the population of interest. Overall, 55 nurse-sensitive outcomes were identified and 47 (85.5%) were operationally defined. These included patient/family satisfaction (n=7, 12.7%), patient complications (n=6, 10.9%), ventilator-related outcomes (n=6, 10.9%), unplanned extubation (n=5, 9.1%), and symptom-related outcomes (n=6, 10.9%). Outcomes differed by patient population and setting.

CONCLUSION

It is important to broaden nurse-sensitive outcome measurement in acute/critical care settings to recognize the full spectrum of nursing's work in hospitals. When core hospital outcome measures reflect the true work of nursing, its value to patients, families, and organizations can be made visible.

Quality indicators in respiratory therapy

Quality indicators in healthcare refer to measurable and quantifiable parameters used to assess and monitor the performance, effectiveness, and safety of healthcare services. These indicators provide a systematic way to evaluate the quality of care offered, and thereby to identify areas for improvement and to ensure that patient care meets established standards and best practices. Respiratory therapists play a vital role in areas of clinical administration such as infection control practices and quality improvement initiatives. Quality indicators serve as essential metrics for respiratory therapy departments to assess and enhance the overall quality of care. By systematically tracking and analyzing indicators related to infection control, treatment effectiveness, and adherence to protocols, respiratory care practitioners can identify areas to improve and implement evidence-based changes. This article reviewed how to identify, implement, and monitor quality indicators specific to the respiratory therapy departments to set benchmarks and enhance patient outcomes.

Construction of nursing care quality evaluation indicators for post-anaesthesia care unit in China

AIMS AND OBJECTIVES

To establish a set of scientific and practical nursing care quality evaluation indicators for PACU in China.

BACKGROUND

No unified nursing care quality evaluation indicators for post-anaesthesia care unit (PACU) were found in China.

DESIGN

An international literature review, domestic cross-sectional survey and two-round e-Delphi study.

METHODS

The international literature review and domestic cross-sectional survey were conducted to identify the potential nursing care quality evaluation indicators for PACU. A total of 38 and 32 indicators were extracted from 24 articles and the cross-sectional survey respectively. Two rounds of e-Delphi study were conducted to collect opinions from a panel of 20 independent experts and establish the final version of the nursing care quality evaluation indicators for PACU. A GRRAS checklist was used to guide the reporting of this study.

RESULTS

Of 20 experts, 19 completed the first round of e-Delphi study and 18 completed the second round, with a response rate of 95% and 90% respectively. The experts' authority coefficient in the two rounds of e-Delphi study was 0.91 and 0.90 respectively. The Kendall W value of the two rounds ranged between 0.108 and 0.385 (p < .01). Four structure indicators, 12 process indicators and seven outcome indicators were included in the nursing care quality evaluation indicators for PACU.

CONCLUSIONS

With the methods of literature review, cross-sectional survey and e-Delphi study, we established a set of scientific and practical nursing care quality evaluation indicators for PACU, to improve the nursing care quality, reduce incidence of complications and ensure patient safety.

RELEVANT TO CLINICAL PRACTICE

The findings from this study enable nurses and managers in PACU settings to evaluate clinical nursing care quality using a robust framework.

Predictive value of the unplanned extubation risk assessment scale in hospitalized patients with tubes

BACKGROUND

Critical patients often had various types of tubes, unplanned extubation of any kind of tube may cause serious injury to the patient, but previous reports mainly focused on endotracheal intubation. The limitations or incorrect use of the unplanned extubation risk assessment tool may lead to improper identification of patients at a high risk of unplanned extubation and cause delay or non-implementation of unplanned extubation prevention interventions. To effectively identify and manage the risk of unplanned extubation, a comprehensive and universal unplanned extubation risk assessment tool is needed.

AIM

To assess the predictive value of the Huaxi Unplanned Extubation Risk Assessment Scale in inpatients.

METHODS

This was a retrospective validation study. In this study, medical records were extracted between October 2020 and September 2021 from a tertiary comprehensive hospital in southwest China. For patients with tubes during hospitalization, the following information was extracted from the hospital information system: age, sex, admission mode, education, marital status, number of tubes, discharge mode, unplanned extubation occurrence, and the Huaxi Unplanned Extubation Risk Assessment Scale (HUERAS) score. Only inpatients were included, and those with indwelling needles were excluded. The best cut-off value and the area under the curve (AUC) of the Huaxi Unplanned Extubation Risk Assessment Scale were been identified.

RESULTS

A total of 76033 inpatients with indwelling tubes were included in this study, and 26 unplanned extubations occurred. The patients’ HUERAS scores were between 11 and 30, with an average score of 17.25 ± 3.73. The scores of patients with or without unplanned extubation were 22.85 ± 3.28 and 17.25 ± 3.73, respectively (P < 0.001). The results of the correlation analysis showed that the correlation coefficients between each characteristic and the total score ranged from 0.183 to 0.843. The best cut-off value was 21, and there were 14135 patients with a high risk of unplanned extubation, accounting for 18.59%. The Cronbach’s α, sensitivity, specificity, positive predictive value, and negative predictive value of the Huaxi Unplanned Extubation Risk Assessment Scale were 0.815, 84.62%, 81.43%, 0.16%, and 99.99%, respectively. The AUC of HUERAS was 0.851 (95%CI: 0.783-0.919, P < 0.001).

CONCLUSION

The HUERAS has good reliability and predictive validity. It can effectively identify inpatients at a high risk of unplanned extubation and help clinical nurses carry out risk screening and management.

Value of Intensive Nursing Detail Management in Intensive Care Unit Nursing

Objective

To evaluate the value of intensive nursing detail management in intensive care unit (ICU) nursing.

Methods

In this prospective study, 100 ICU patients in Shiyan Maternal and Child Health Hospital between January 2019 and March 2020 were assessed for eligibility and recruited. They were concurrently randomly assigned (1 : 1) to receive either conventional nursing (control group) or intensive nursing detail management (study group). The clinical endpoint was the nursing efficiency.

Results

Intensive nursing detail management was associated with significantly higher scores in basic nursing, quality of nursing, and quality of management versus conventional nursing (P < 0.05). Intensive nursing detail management resulted in a significantly higher adequate nursing rate (96.00%) versus conventional nursing (74.00%) (P < 0.05). The patients given intensive nursing detail management had a shorter hospital stay versus those receiving conventional nursing (P < 0.05). Intensive nursing detail management was associated with a higher nursing satisfaction rate (74.00%) versus conventional nursing (70.00%) (P < 0.05).

Conclusion

Intensive nursing detail management is effective and safe in ICU nursing, so it is worthy of clinical application.

Analysis of Risk Factors of Hospital Emergency Nursing Based on Comprehensive Nursing Methods

In order to improve the comprehensive nursing effect of the hospital emergency treatment, this paper analyzes the process of the hospital emergency treatment. In addition, this paper combines the possible risks to analyze the risk factors of the comprehensive nursing in the hospital emergency treatment and builds an intelligent analysis model based on the actual situation of the hospital emergency treatment. At the same time, this paper conducts a systematic survey of emergency services and gives the composition and structure of the system. In addition, this paper divides the business required by the system into modules, including registration module, doctor workstation, nurse workstation, query statistics module, decision-making module, and maintenance module. Finally, this paper suggests that in the process of the clinical triage, more ideas for improving the existing evaluation model should be proposed, and experience should be transformed into advantages, so as to improve emergency triage skills; establish an objective, quantitative, and scientific concept of emergency classification and triage; and fully realize scientific triage and precise triage.