S/N SHINY VARGHESE Neurosurgery ICU, JPNATC

Effect of New Joinees as Staff Nurses on patient

care in Neurosurgery ICU

BACKGROUND

• A major limitation in improving patient care has

been the shortage of staff nurses.

In the control phase staff patient ratio was

1:3 , 1:4 which affected the delivery of quality care

nursing, affecting the patient outcome in terms of

infection and mortality rate.

• Sudden increase in nursing strength by

inexperienced nurses brings with it its own set of

difficulties in patient care.

BACKGROUND (cont…….)

• It is hypothesized that

sudden influx of

inexperienced nurses

may be detrimental for

patient care in the

short term especially

in absence of

structured training &

mentorship program in

place.

AIMS & OBJECTIVES

To assess the effect of new

joinees as staff nurses on patient

care in neurosurgery ICU using

infection rate and mortality rate as

the surrogate markers for nursing

care.

MATERIAL & METHODS

• In this retro-prospective study in

neurosurgery ICU over 6 months( Oct

2010- Mar 2011), the infection rates

(using blood, tracheal & urine culture

reports) were calculated for a group of

patients.

• There was sudden increase in new joinees

by 100% in Decmeber 2010

Different phases

1) Control phase (Oct 2010-Nov 2010)

When the nurse:patient ratio was 1:4

2) Training phase (Dec 2010-Jan 2010)

When the nurse: patient ration was 1:1 but new

nurses were inexperienced

3) Final phase (Feb 2011-march 2011)

When the nurse: patient ration was 1:1 and all

nurses had been trained in neuro-ICU care.

EVALUATION PARAMETERS

1. GROSS INFECTION RATE

This is defined as no. of patients getting

infected(tracheal, urine and blood ) in respect of total no.

of patients getting admitted in neurosurgery, ICU in a

particular phase.

2. HOSPITAL MORTALITY RATE

This is defined as no. of deaths in respect

of total no. of patients in a particular phase.

3. NURSE PATIENT RATIO IN EACH PHASE

The average no. of patients a nurse is

assigned with

in a particular phase.

SEVERITY OF HEAD INJURY

This is judged on the basis of G.C.S (Glassgow Coma Scale)

Head injury Average G.C.S

Severe head injury 3-6

Moderate head injury 7-11

Minor head injury 12-15

S No.

Phases Nurse Patient ratio

Total no. of

patients

No. of deaths

%

1. CONTROL PHASE

1:4 (evening and night shift)

1:3 (morning shift)

266 48 18 %

2. TRAINING PHASE

1:1 (inexperienced and untrained )

255 42 16.4 %

3. FINAL PHASE

1:1 (fully trained) 216 33 15.3 %

RESULT

HOSPITAL MORTALITY RATE

GROSS INFECTION RATE

INFECTION IN TRACHEAL CULTURE

S No.

Phases Nurse Patient ratio

Total no. of

patients

No. of culture positiv

e patient

s

%

1. CONTROL PHASE

1:4 (evening and night shift)

1:3 (morning shift)

266 166 62.3 %

2. TRAINING PHASE

1:1 (inexperienced and untrained )

255 151 59.3 %

3. FINAL PHASE

1:1 (fully trained) 216 48 22.3 %

INFECTION IN URINE CULTURE

S No.

Phases Nurse Patient ratio

Total no. of

patients

No. of culture positiv

e patient

s

%

1. CONTROL PHASE

1:4 (evening and night shift)

1:3 (morning shift)

266 130 48.9 %

2. TRAINING PHASE

1:1 (inexperienced and untrained )

255 87 34.2 %

3. FINAL PHASE

1:1 (fully trained) 216 27 12.6 %

INFECTION IN BLOOD CULTURE

S No.

Phases Nurse Patient ratio

Total no. of

patients

No. of culture positiv

e patient

s

%

1. CONTROL PHASE

1:4 (evening and night shift)

1:3 (morning shift)

266 66 24.9 %

2. TRAINING PHASE

1:1 (inexperienced and untrained )

255 37 14.5 %

3. FINAL PHASE

1:1 (fully trained) 216 9 4.2 %

CONCLUSIONS

• There is significant decrease in mortality

following introduction of 1:1 nursing in neurosurgery

ICU.

• The severity of head injury was approximately

in the same range of all the phases hence it has no

significant role to play in the reduction of mortality

rate.

• This mortality further decreased significantly

following in house training to new recruits.

CONCLUSIONS

• There is a significant role of nurse patient ratio in

the improvement of nursing care standards as it is

obvious from the study that by making nurse patient

ratio 1:1 there is a huge decrease in infection rate.

• Blood infection rate (4.25), tracheal infection

rate (22.3%) & urine infection rate (12.6%) in the final

phase were significantly lower (p<0.001) than the

preceding two phases.

• There was no significant difference between the

control & training phases in the incidence of blood,

tracheal & urine infection. However, Trend towards

improvement in all parameters of patient outcome is

seen following the induction of fresh staff nurses in

the system which became significant later.

• Structured programs and mentorship plays a

vital role in improving the nursing practices .

CONCLUSION