Nursing workload and occurrence of adverse events in intensive care: a systematic review

Abstract

Objective:To identify evidences of the influence of nursing workload on the occurrence of adverse events (AE) in adult patients admitted to the intensive care unit (ICU). Method: A systematic literature review was conducted in the databases MEDLINE, CINAHL, LILACS, SciELO, BDENF, and Cochrane from studies in English, Portuguese, or Spanish, published by 2015. The analyzed AE were infection, pressure ulcer (PU), patient falls, and medication errors. Results: Of 594 potential studies, eight comprised the final sample of the review. The Nursing Activities Score (NAS; 37.5%) and the Therapeutic Intervention Scoring System (TISS; 37.5%) were the instruments most frequently used for assessing nursing workload. Six studies (75.0%) identified the influence of work overload in events of infection, PU, and medication errors. An investigation found that the NAS was a protective factor for PU. Conclusion: The nursing workload required by patients in the ICU influenced the occurrence of AE, and nurses must monitor this variable daily to ensure proper sizing of staff and safety of care.

Dimensioning of hospital nursing personnel: study with brazilian official parameters of 2004 and 2017

“…8 Reinforcing the rationale for identifying and studying staff dimensioning, it is known that, at the international level, the high workload of the nursing team -commonly associated with the quantitative deficit of professionals -can directly compromise the care quality. It can contribute, for example, to a higher risk of death with the reduction of the proportion of nurses per patient, 9 increased rates of adverse events, such as pressure injuries, falls, errors in drug administration 10 and hospital infections, and increased length of hospitalization.…”

Dimensionamento De Pessoal De Enfermagem Na Uti-Adulto De Hospital Universitário Público

“…No contexto de UTI, o aumento da carga de trabalho da equipe de enfermagem -comumente associado ao déficit no quadro de pessoal -têm apresentado resultados alarmantes ao cuidado dos pacientes, tais como: aumento da permanência na internação (8) ; elevação dos índices de infecções relacionadas à assistência, lesões por pressão, quedas e erros na administração de medicamentos (9) ; e até mesmo a maior propensão à morte (10) . Considerando a relevância da equipe de enfermagem na qualidade e segurança do atendimento em UTI, bem como da atualização recente da Resolução oficial que rege o dimensionamento de pessoal no Brasil, considera-se que investigar o tema em pauta é social e cientificamente relevante, uma vez que os resultados de pesquisas podem ser um subsídio formal e atualizado para possível readequação de pessoal.…”

“…Não menos importante, ressalta-se que os estudos recentes relacionam a carga de trabalho de enfermagem em UTI, e não o próprio dimensionamento como objeto de pesquisa (6)(7)(8)(9)(10)(11) , o que reforça a justificativa para novas pesquisas.…”

Eventos adversos na unidade de terapia intensiva

“…18 Some sedatives may lead the patient to present delusions that, in turn , generate agitation. 25 The percentage of IAHC affects 13 to 22% of ICU patients. 18,25 Mechanical ventilation pneumonias (VAPs) are the most common type of respiratory infections among ICU infections, usually of aspiration origin of secretions of the upper airways.…”

“…25 The percentage of IAHC affects 13 to 22% of ICU patients. 18,25 Mechanical ventilation pneumonias (VAPs) are the most common type of respiratory infections among ICU infections, usually of aspiration origin of secretions of the upper airways. 12 Among the main measures, that may contribute to the reduction of VAP, are hygiene of the hands, high 30-45º decubitus, the aspiration of the airways, the maintenance of endotracheal cuff pressures and the oral hygiene with oral chlorhexidine.…”