Impact of Different Sampling Strategies on Score Results of the Nine Equivalents of Nursing Manpower Use Score (NEMS)

Abstract

Summary Objective: Prospective observational study to assess the impact of two differentsampling strategies on the score results of the NEMS, used widely to estimate the amount of nursing workload in an ICU. Methods: NEMS scores of all patients admitted to the surgical ICU over a one-year period were automatically calculated twice a day with a patient data management system for each patient day on ICU using two differentsampling strategies (NEMSindividual: 24-hour intervals starting from the time of admission; NEMS8a.m.: 24-hour intervals starting at 8 a.m.). Results: NEMSindividual and NEMS8a.m. were collected on 3236 patient days; 687 patients were involved. Significantly lower scores were found for the NEMS8a.m. (25.0 ± 8.7) compared to the NEMSindividual (26.1 ± 8.9, p <0.01); the interclass correlation coefficient (ICC) was good but not excellent: 0.78. The inter-rater correlation between the two NEMS scores was high or very high (κ = 0.6-1.0) for six out of nine variables of the NEMS. Conclusions: Different sampling strategies produce different score values, especiallydueto the end of stay. This has to betaken into accountwhen using the NEMS in quality assurance projects and multi-center studies.

Nine Equivalents of Nursing Manpower Use Score (NEMS): um estudo de seu processo histórico

“…O Nine Equivalents of Nursing Manpower Use Score tem sido utilizado em diversos estudos para avaliar gestão de recursos humanos em UTI, avaliação e comparação de nível de trabalho em UTI, bem como para a previsão e o planejamento de pessoal de enfermagem individual e coletivamente (estudos multicêntrico) em UTI (11,12,17,18) . Desenvolver sistema de escore de intervenção terapêutica baseado no TISS-28 e validá-lo em base de dados independente 9 itens correspondentes a procedimentos e intervenções realizadas dentro ou fora da UTI.…”

“…O TISS-28 foi traduzido e validado para o português através de um estudo (9) . Este escore otimizou o tempo de coleta de dados (10) , ainda que estudos apontem como limitação do escore o tempo despendido na realização desta rotina (11) .…”

Correlation between the TISS‐28 and NEMS indicators in an intensive care unit

“…In addition, studies conducted in several countries have sought to evaluate and/or relate NEMS scores for hospitalized patients to the mortality prognosis, as well as the quantification of nursing workload, seeking comparisons between different ICUs. The main advantages of using NEMS are the reduction in data collection time and the ease with which this score can be applied . Limitations were also observed in studies, where it was found that NEMS has less discriminative power when compared with TISS‐28: patients with the same score do not always require the same care; patient age can influence the score value; it does not include nursing activities not related to patient care …”

“…The main advantages of using NEMS are the reduction in data collection time and the ease with which this score can be applied. [4][5][6] Limitations were also observed in studies, where it was found that NEMS has less discriminative power when compared with TISS-28: patients with the same score do not always require the same care; patient age can influence the score value; it does not include nursing activities not related to patient care. 7 Research with nursing indicators is still ongoing in Brazil.…”

Validação Concorrente de Escores de Enfermagem (NEMS e TISS-28) em terapia intensiva pediátrica

“…(1,5,6) The NEMS is also appropriate for the management of nursing professionals who work in intensive therapy and for the evaluation of ICUs. (7)(8)(9) Studies validating NEMS were implemented with clinical and surgical patients hospitalized in adult ICUs, (4,10) however, such studies are rare and seldom implemented in pediatric units.…”