School of Nursing, Midwifery and Postgraduate Medicine, Edith Cowan University, Perth, Western Australia, Australia.
Int J Nurs Stud. 2011 May;48(5):540-8. doi: 10.1016/j.ijnurstu.2010.07.013. Epub 2010 Aug 8.
In March 2002 the Australian Industrial Relations Commission ordered the introduction of a new staffing method - nursing hours per patient day (NHPPD) - for implementation in Western Australia public hospitals. This method used a "bottom up" approach to classify each hospital ward into one of seven categories using characteristics such as patient complexity, intervention levels, the presence of high dependency beds, the emergency/elective patient mix and patient turnover. Once classified, NHPPD were allocated for each ward.
The objective of this study was to determine the impact of implementing the NHPPD staffing method on 14 nursing-sensitive outcomes: central nervous system complications, wound infections, pulmonary failure, urinary tract infection, pressure ulcer, pneumonia, deep vein thrombosis, ulcer/gastritis/upper gastrointestinal bleed, sepsis, physiologic/metabolic derangement, shock/cardiac arrest, mortality, failure to rescue and length of stay.
The research design was an interrupted time series using retrospective analysis of patient and staffing administrative data from three adult tertiary hospitals in metropolitan Perth over a 4-year period.
All patient records (N=236,454) and nurse staffing records (N=150,925) from NHPPD wards were included.
The study found significant decreases in the rates of nine nursing-sensitive outcomes when examining hospital-level data following implementation of NHPPD; mortality, central nervous system complications, pressure ulcers, deep vein thrombosis, sepsis, ulcer/gastritis/upper gastrointestinal bleed shock/cardiac arrest, pneumonia and average length of stay. At the ward level, significant decreases in the rates of five nursing-sensitive outcomes; mortality, shock/cardiac arrest, ulcer/gastritis/upper gastrointestinal bleed, length of stay and urinary tract infections occurred.
The findings provide evidence to support the continuation of the NHPPD staffing method. They also add to evidence about the importance of nurse staffing to patient safety; evidence that must influence policy. This study is one of the first to empirically review a specific nurse staffing method, based on an individual assessment of each ward to determine staffing requirements, rather than a "one-size-fits-all" approach.
2002 年 3 月，澳大利亚劳资关系委员会下令在西澳大利亚公立医院采用新的人员配备方法——每患者护理时数（NHPPD）。该方法采用“自下而上”的方法，根据患者复杂性、干预水平、高依赖床位、急诊/择期患者混合和患者周转率等特点，将每个病房分为七个类别之一。分类后，为每个病房分配 NHPPD。
本研究的目的是确定实施 NHPPD 人员配备方法对 14 个护理敏感结果的影响：中枢神经系统并发症、伤口感染、肺衰竭、尿路感染、压疮、肺炎、深静脉血栓形成、溃疡/胃炎/上消化道出血、败血症、生理/代谢紊乱、休克/心脏骤停、死亡率、救援失败和住院时间。
研究设计是使用回顾性分析，对珀斯大都市区的三家成人三级医院的患者和人员配备管理数据进行 4 年的时间序列分析。
包括 NHPPD 病房的所有患者记录（N=236454）和护士人员配备记录（N=150925）。
研究发现，在实施 NHPPD 后，检查医院层面的数据时，九个护理敏感结果的发生率显著下降；死亡率、中枢神经系统并发症、压疮、深静脉血栓形成、败血症、溃疡/胃炎/上消化道出血、休克/心脏骤停、肺炎和平均住院时间。在病房层面，五个护理敏感结果的发生率显著下降；死亡率、休克/心脏骤停、溃疡/胃炎/上消化道出血、住院时间和尿路感染。
研究结果为继续实施 NHPPD 人员配备方法提供了证据。它们还增加了关于护士人员配备对患者安全重要性的证据；这一证据必须影响政策。这项研究是首批根据每个病房的个体评估来确定人员配备需求的具体护士人员配备方法进行实证审查的研究之一，而不是采用“一刀切”的方法。
