Ream Robert S, Mackey Kevin, Leet Terry, Green M Christine, Andreone Teresa L, Loftis Laura L, Lynch Robert E
Division of Critical Care, Department of Pediatrics, Saint Louis University, St Louis, MO, USA.
Pediatr Crit Care Med. 2007 Jul;8(4):366-71. doi: 10.1097/01.PCC.0000269379.40748.AF.
To estimate nursing workload from the patient acuity level (PAL) assigned to patients in a pediatric intensive care unit (PICU) and to determine its influence on unplanned extubations.
Prospective cohort study.
The 19-bed PICU of an urban, university-affiliated, tertiary children's hospital.
All patients admitted to the PICU.
None.
The study encompassed 2,193 nursing shifts and 1,919 admissions to the PICU over 24 months. The shift census averaged 12.0 patients (range 5-18) and was staffed by 9.4 nurses (range 4-16) for an average patient/nurse ratio of 1.3 +/- 0.2. Patients were assigned a PAL of 1-7 based on a classification system derived from time studies of 12 general nursing tasks. The total PALs per shift divided by the number of nursing staff yielded an average assignment of 5.8 +/- 0.7 PALs. Forty unplanned extubations (0.76 unplanned extubations/100 ventilator days) were observed during the study period. Logistic regression revealed positive associations between unplanned extubations and patient/nurse ratio (p = .03) and the shift PAL/nurse ratio (p = .01). The likelihood of an unplanned extubation when nurses covered >6.3 PALs was 3.8 times higher than during those shifts when they covered <5.3 PALs.
The likelihood of an unplanned extubation increased with higher patient/nurse and patient acuity/nurse ratios. Successful interventions to reduce the frequency of this medical error may need to address both nurse demand methodology and workload.
根据分配给儿科重症监护病房（PICU）患者的病情严重程度（PAL）评估护理工作量，并确定其对意外拔管的影响。
前瞻性队列研究。
一所城市大学附属医院的拥有19张床位的PICU。
所有入住PICU的患者。
无。
该研究涵盖了24个月内PICU的2193个护理班次和1919例入院患者。每班平均患者人数为12.0人（范围为5 - 18人），配备9.4名护士（范围为4 - 16人），平均护患比为1.3±0.2。根据对12项一般护理任务的时间研究得出的分类系统，为患者分配1 - 7级的PAL。每班的总PAL数除以护理人员数量得出平均每人分配5.8±0.7个PAL。在研究期间观察到40例意外拔管（0.76例意外拔管/100个呼吸机日）。逻辑回归显示意外拔管与护患比（p = 0.03）和每班PAL/护士比（p = 0.01）呈正相关。当护士负责的PAL数>6.3时，意外拔管的可能性比负责的PAL数<5.3时高出3.8倍。
意外拔管的可能性随着护患比和患者病情严重程度/护士比的升高而增加。减少此类医疗差错发生频率的成功干预措施可能需要同时解决护士需求方法和工作量问题。
