COMPARISON BETWEEN PATIENT SEVERITY AND NURSING WORKLOAD BEFORE AND AFTER THE OCCURRENCE OF ADVERSE EVENTS IN ELDERLY IN CRITICAL CARE

Toffoletto, Maria Cecilia; Oliveira, Elaine Machado de; Andolhe, Rafaela; Barbosa, Ricardo Luis; Padilha, Katia Grillo

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Original Article • Texto contexto - enferm. 27 (1) • 2018 • https://doi.org/10.1590/0104-070720180003780016 copy

COMPARISON BETWEEN PATIENT SEVERITY AND NURSING WORKLOAD BEFORE AND AFTER THE OCCURRENCE OF ADVERSE EVENTS IN ELDERLY IN CRITICAL CARE

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to compare the patient severity and the nursing workload before and after the occurrence of moderate and severe adverse events in elderly hospitalized at intensive care units.

Method:

comparative study developed at nine intensive therapy units of a University Hospital in São Paulo. The events were collected from the patient histories and classified as moderate and severe according to the World Health Organization. For the severity analysis, the Simplified Acute Physiologic Score II was used and, for the workload analysis, the Nursing Activities Score was applied 24 hours before and after the moderate and severe event. The t-test with 5% significance was used to compare the mean clinical severity and workload scores before and after the event.

Results:

the sample consisted of 315 elderly, 94 (29.8%) of whom were victims of moderate and severe events at the units. Among the 94 events, the clinical process and procedure type was predominant (40.0%). The installation and maintenance of therapeutic artifacts and catheters were the prevalent interventions that resulted in moderate (76.5%) physiopathological damage (66.0%). The mean workload score (75.19%) dropped 24 hours after the occurrence of the event (71.97%, p=0.008), and the severity, represented by the probability of death, increased from 22.0% to 29.0% after the event (p=0.045).

Conclusion:

in the patient safety context, the identification of the changes in clinical conditions and the nursing workload in elderly victims of events supports the prevention of these occurrences.

DESCRIPTORS:
Aged; Intensive care units; Patient safety; Nursing care; Workload; Mortality

		Adverse Event		Total	p-value*
		No	Yes	Total	p-value*
Age	n	221	94	315	0.438
	Mean	71.53	70.76	71.30
	Stand. Deviation	8.19	7.83	8.08
	Min.-Max.	60-99	60-91	60-99
Charlson	n	221	94	315	0.150
	Mean	1.76	2.11	1.86
	Stand. Deviation	1.85	2.23	1.97
	Min.-Max.	0-9	0-12	0.12
Length of stay	n	221	94	315	0.000
	Mean	5.06	10.62	6.72
	Stand. Deviation	6.47	9.30	7.84
	Min.-Max.	1-59	1-47	1-59
Nursing Activities Score	n	221	94	315	0.082
	Mean	71.20	74.27	72.12
	Stand. Deviation	13.49	15.95	14.31
	Min.-Max.	31-137	49-173	31-173
Simplified Acute Physiologic Score II (Mortality Risk %)	n	221	94	315	0.073
	Mean	0.17	0.22	0.18
	Stand. Deviation	0.19	0.23	0.21
	Min.-Max.	0.00-0.84	0.00-.95	0.00-.95

		Adverse Event				p-value^* * Pearson's chi-square test
			No	Yes
		n	%	n	%
Origin	Non-critical area	148	66.9	50	53.2	0.021
Origin	Critical area	73	33.1	44	46.8
Total		221	100	94	100
Exit condition	Survivor	168	76.0	58	61.7	0.010
Exit condition	Non-survivor	53	24.0	36	38.3
Total		221	100	94	100

		Adverse Event				p-value^* * Pearson's chi-squared
		No		Yes
	n	%	n	%
Installation and maintenance of therapeutic artifacts/catheters	No	125	56.6	22	23.4	0.000
	Yes	96	43.4	72	76.6
Total		221	100	94	100
Medication administered by infusion pumps	No	119	53.9	20	21.3	0.000
Medication administered by infusion pumps	Yes	102	46.1	74	78.7
Total		221	100	94	100
Invasive and non-invasive intubation/mechanical ventilation	No	147	66.5	25	26.6
Invasive and non-invasive intubation/mechanical ventilation	Yes	74	33.5	69	73.4	0.000
Total		221	100	94	100
Airway aspiration	No	176	79.6	44	46.8	0.000
Airway aspiration	Yes	45	20.4	50	53.2
Total		221	100	94	100
Vasoactive drug administration	No	139	62.9	27	28.7	0.000
Vasoactive drug administration	Yes	82	37.1	67	71.3
Total		221	100	94	100

		Adverse Event		p-value
		Before	After	p-value
Nursing Activities Score	n Mean Stand. Deviation Standard Error	94 75.19 15.43 1.59	94 71.97 13.26 1.36	0.008
Simplified Acute Physiologic Score II	n Mean Stand. Deviation Standard Error	94 0.22 0.23 0.02	94 0.29 0.23 0.02	0.045

Universidade Federal de Santa Catarina, Programa de Pós Graduação em Enfermagem Campus Universitário Trindade, 88040-970 Florianópolis - Santa Catarina - Brasil, Tel.: (55 48) 3721-4915 / (55 48) 3721-9043 - Florianópolis - SC - Brazil
E-mail: textoecontexto@contato.ufsc.br

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[1] Correspondence: Maria Cecilia Toffoletto, Universidad Andrés Bello - Facultad de Enfermería, Calle Sazie, 2212, Republica Santiago, 8320000, Santiago, Chile. E-mail: mtoffoletto@unab.cl