Implementation of NAS in a General Adult ICU and Assessment of Nurse-to-Patient Ratios and Nursing Adverse Outcomes

Introduction: Nursing workload scales consist valuable tools for the assessment of provided care’s quality, including the nurse staffing. However, the incidence of nursing adverse outcomes has not been investigated. Aim: The implementation of Nursing Activities Score (NAS) in an adult ICU and the evaluation of nurse staffing and nursing adverse outcomes. Material and Μethod: A prospective cohort study was performed in a general ICU of Athens during November 2017 (30 continuous days) in a sample of 21 hospitalized patients (1 readmission). Data were collected via a demographic-clinical data collection sheet, a nursing adverse outcomes sheet and also the NAS score sheet, which was completed daily from the same researcher. 258 daily records were collected with NAS. Descriptive statistics and correlational analyses were performed using SPSS 24.0 (p≤0.05). Results: Patients’ demographic and clinical data were: gender (male 57%), mean age (67,71±13,73 years), mean length of ICU stay (36,81 days) (median=18 days). The mean score of NAS (±SD) was 65,2 (±7,55). The incidence density of catheter-related bloodstream infection (CRBSI), ventilator-associated pneumonia (VAP), catheter-associated urinary tract infection (CAUTI), unplanned extubation and unplanned removal of the feeding tube was 8,197/1000 days, 21,277/1000 days, 19,380/1000 days, 0/1000 days and 17,241/1000 days, respectively. The optimal nurse to patient ratio according to NAS was 1:1,54 (1:1,40–1:1,65), while the actual ratio was 1:2,30 (1:1,85–1:2,70). The actual nurse to patient ratios were statistically significantly negatively correlated with the NAS scores (–0,597≤rho≤–0,590, p<0,001). Conclusions: During the study the ICU was understaffed, while the incidence of nursing sensitive outcomes was increased. Reduced nurse to patient ratios lead to increased nursing workload.