Εντοπισμός και επιλογή κλινικών δεικτών ποιότητας αξιολόγησης της παρεχόμενης νοσηλευτικής φροντίδας, καθώς και δοκιμαστική εφαρμογή τους στη Μονάδα Εντατικής Θεραπείας του Γενικού Νοσοκομείου Λευκωσίας

Abstract

Introduction Nurses play an important role on patients’ health outcomes in the Intensive Care Unit (ICU). Literature lacks of a set of quality indicators (QIs) that quantifies the nursing care delivered in the ICU. Aim The development of a set of nursing sensitive QIs and its pilot testing. Methods It is a combination of a methodological study investigating and achieving a consensus among participants of two groups of experts (A and B). A Delphi method approach and descriptive observational methods were used. More specifically, a two round Delphi study of 139 and seven experts were employed in Group A and B, respectively, using a questionnaire which included nursing sensitive QIs. In round one, the pri ori level of concensus was set to 60% among the two groups of experts, and in round two the Context Validity Index (CVI) was taken into consideration. The selected QIs revealed from the Delphi study were recorded on daily basis. The sample consisted of 321 ICU patients that were admitted in the ICU within the time period of six months. Chi square tests were applied to investigate the possible statistical significant correlations. Results The Delphi study extracted 15 nursing QIs. Heterogenity was observed between the experts regarding the country of origin, the age, the background and clinical experience. Country of origin and education were the main characteristics that were associated to positive responses based on the criteria set at the beginning (p<0,001). The incidence rates for infections recorded in the ICU for a six month period time were: surgical wound infection (1,9%), urinary tract infection associated to urethral catheter (2,8%), multidrug resistant infections (14%), central line associated blood stream infections (3,7%) and ventilator associated pneumonia (VAP) (2,5%). The incidence rates for pressure ulcers were found 4,05% and for accidental extubation were found 0,3%. Physical restraints were applied in 3,74% of the sample. Accidental removal of intravascular catheters, removal of nasogastric tube due to occlusion and falls were not observed. Length of stay was significantly associated with infection and complication occurrence (p<0,001). The development of complication and infection in the ICU was significantly associated with patients’ outcomes (p<0,019) and ventilator days (p<0,001), respectively. The newly onset infection development was significantly associated with the number of days using an external device: nasogastric tube (p<0,001), central line catheter (p<0,001) and urethral catheter (p<0,001). Conclusions The set of nursing QIs proposed in the current PhD thesis is evidence based and includes relevant and valid QIs that quantify nursing care delivered in the ICU. Delphi methodology was found to be the most appropriate for the current study and the form used in the ICU as a user friendly tool. In this study, the incidence of selected nursing QIs in a particular ICU is presented through pilot testing. The set of nursing QIs may be applied in similar type of ICUs.