effect of new joinees as staff nurses on patient care in neurosurgery icu
DESCRIPTION
INTRODUCTIONA major limitation in improving patient care has been the shortage of staff nurses. In the control phasestaff patient ratio was 1:3 , 1:4 which affected the delivery of quality care nursing, affecting the patientoutcome in terms of infection and mortality rate.It is hypothesized that sudden influx of inexperienced nurses may be detrimental for patient care in theshort term especially in absence of structured training & mentorship program in place.AIMS AND OBJECTIVESTo assess the effect of new joinees as staff nurses on patient care in neurosurgery ICU using infectionrate and mortality rate as the surrogate markers for nursing care.MATERIALS AND METHODSIn this retro-prospective study in neurosurgery ICU over 6 months( Oct 2010- Mar 2011), the infectionrates (using blood, tracheal & urine culture reports) were calculated for a group of patients.RESULTHospital Mortality Rate and Gross Infection Rates in terms of tracheal, urine and blood cultures wereassessed . severity of head injury was also assessed as it can act as a ditermental factor affectingHospital mortality rate in control phase 18%, in training phase 16.4 % and final phase 15.3%Gross infection rates: tracheal culture incidence in control phase 62.3%, traning phase 59.3%, final phase22.3% . in terms of urine culture incidence control phase 48.9%, training phase 34.2%, final phase 12.6%and for blood culture it was 24.9% in control phase, 14.5% in training phase and 4.2 in final phase.CONCLUSION•There is significant decrease in mortality following introduction of 1:1 nursing in neurosurgeryICU.•The severity of head injury was approximately in the same range of all the phases hence it hasno significant role to play in the reduction of mortality rate.•Blood infection rate (4.25), tracheal infection rate (22.3%) & urine infection rate (12.6%) in thefinal phase were significantly lower (pTRANSCRIPT
S/N SHINY VARGHESE Neurosurgery ICU, JPNATC
Effect of New Joinees as Staff Nurses on patient
care in Neurosurgery ICU
BACKGROUND
• A major limitation in improving patient care has
been the shortage of staff nurses.
In the control phase staff patient ratio was
1:3 , 1:4 which affected the delivery of quality care
nursing, affecting the patient outcome in terms of
infection and mortality rate.
• Sudden increase in nursing strength by
inexperienced nurses brings with it its own set of
difficulties in patient care.
BACKGROUND (cont…….)
• It is hypothesized that
sudden influx of
inexperienced nurses
may be detrimental for
patient care in the
short term especially
in absence of
structured training &
mentorship program in
place.
AIMS & OBJECTIVES
To assess the effect of new
joinees as staff nurses on patient
care in neurosurgery ICU using
infection rate and mortality rate as
the surrogate markers for nursing
care.
MATERIAL & METHODS
• In this retro-prospective study in
neurosurgery ICU over 6 months( Oct
2010- Mar 2011), the infection rates
(using blood, tracheal & urine culture
reports) were calculated for a group of
patients.
• There was sudden increase in new joinees
by 100% in Decmeber 2010
Different phases
1) Control phase (Oct 2010-Nov 2010)
When the nurse:patient ratio was 1:4
2) Training phase (Dec 2010-Jan 2010)
When the nurse: patient ration was 1:1 but new
nurses were inexperienced
3) Final phase (Feb 2011-march 2011)
When the nurse: patient ration was 1:1 and all
nurses had been trained in neuro-ICU care.
EVALUATION PARAMETERS
1. GROSS INFECTION RATE
This is defined as no. of patients getting
infected(tracheal, urine and blood ) in respect of total no.
of patients getting admitted in neurosurgery, ICU in a
particular phase.
2. HOSPITAL MORTALITY RATE
This is defined as no. of deaths in respect
of total no. of patients in a particular phase.
3. NURSE PATIENT RATIO IN EACH PHASE
The average no. of patients a nurse is
assigned with
in a particular phase.
SEVERITY OF HEAD INJURY
This is judged on the basis of G.C.S (Glassgow Coma Scale)
Head injury Average G.C.S
Severe head injury 3-6
Moderate head injury 7-11
Minor head injury 12-15
S No.
Phases Nurse Patient ratio
Total no. of
patients
No. of deaths
%
1. CONTROL PHASE
1:4 (evening and night shift)
1:3 (morning shift)
266 48 18 %
2. TRAINING PHASE
1:1 (inexperienced and untrained )
255 42 16.4 %
3. FINAL PHASE
1:1 (fully trained) 216 33 15.3 %
RESULT
HOSPITAL MORTALITY RATE
GROSS INFECTION RATE
INFECTION IN TRACHEAL CULTURE
S No.
Phases Nurse Patient ratio
Total no. of
patients
No. of culture positiv
e patient
s
%
1. CONTROL PHASE
1:4 (evening and night shift)
1:3 (morning shift)
266 166 62.3 %
2. TRAINING PHASE
1:1 (inexperienced and untrained )
255 151 59.3 %
3. FINAL PHASE
1:1 (fully trained) 216 48 22.3 %
INFECTION IN URINE CULTURE
S No.
Phases Nurse Patient ratio
Total no. of
patients
No. of culture positiv
e patient
s
%
1. CONTROL PHASE
1:4 (evening and night shift)
1:3 (morning shift)
266 130 48.9 %
2. TRAINING PHASE
1:1 (inexperienced and untrained )
255 87 34.2 %
3. FINAL PHASE
1:1 (fully trained) 216 27 12.6 %
INFECTION IN BLOOD CULTURE
S No.
Phases Nurse Patient ratio
Total no. of
patients
No. of culture positiv
e patient
s
%
1. CONTROL PHASE
1:4 (evening and night shift)
1:3 (morning shift)
266 66 24.9 %
2. TRAINING PHASE
1:1 (inexperienced and untrained )
255 37 14.5 %
3. FINAL PHASE
1:1 (fully trained) 216 9 4.2 %
CONCLUSIONS
• There is significant decrease in mortality
following introduction of 1:1 nursing in neurosurgery
ICU.
• The severity of head injury was approximately
in the same range of all the phases hence it has no
significant role to play in the reduction of mortality
rate.
• This mortality further decreased significantly
following in house training to new recruits.
CONCLUSIONS
• There is a significant role of nurse patient ratio in
the improvement of nursing care standards as it is
obvious from the study that by making nurse patient
ratio 1:1 there is a huge decrease in infection rate.
• Blood infection rate (4.25), tracheal infection
rate (22.3%) & urine infection rate (12.6%) in the final
phase were significantly lower (p<0.001) than the
preceding two phases.
• There was no significant difference between the
control & training phases in the incidence of blood,
tracheal & urine infection. However, Trend towards
improvement in all parameters of patient outcome is
seen following the induction of fresh staff nurses in
the system which became significant later.
• Structured programs and mentorship plays a
vital role in improving the nursing practices .
CONCLUSION