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Nursing activities score

Miranda, Dinis Reis MD, PhD, FCCM; Nap, Raoul MSc, Biostat; de Rijk, Angelique MA, PhD; Schaufeli, Wilmar MA, PhD; Iapichino, Gaetano MD

doi: 10.1097/01.CCM.0000045567.78801.CC
Clinical Investigations

Objectives The instruments used for measuring nursing workload in the intensive care unit (e.g., Therapeutic Intervention Scoring System-28) are based on therapeutic interventions related to severity of illness. Many nursing activities are not necessarily related to severity of illness, and cost-effectiveness studies require the accurate evaluation of nursing activities. The aim of the study was to determine the nursing activities that best describe workload in the intensive care unit and to attribute weights to these activities so that the score describes average time consumption instead of severity of illness.

Design To define by consensus a list of nursing activities, to determine the average time consumption of these activities by use of a 1-wk observational cross-sectional study, and to compare these results with those of the Therapeutic Intervention Scoring System-28.

Setting A total of 99 intensive care units in 15 countries.

Patients Consecutive admissions to the intensive care units.

Intervention Daily recording of nursing activities at a patient level and random multimoment recording of these activities.

Results A total of five new items and 14 subitems describing nursing activities in the intensive care unit (e.g., monitoring, care of relatives, administrative tasks) were added to the list of therapeutic interventions in Therapeutic Intervention Scoring System-28. Data from 2,041 patients (6,451 nursing days and 127,951 multimoment recordings) were analyzed. The new activities accounted for 60% of the average nursing time; the new scoring system (Nursing Activities Score) explained 81% of the nursing time (vs. 43% in Therapeutic Intervention Scoring System-28). The weights in the Therapeutic Intervention Scoring System-28 are not derived from the use of nursing time.

Conclusions Our study suggests that the Nursing Activities Score measures the consumption of nursing time in the intensive care unit. These results should be validated in independent databases.

Supplemental Digital Content is Available in the Text.

From the University Hospital Groningen, Groningen, The Netherlands (DRM, RN); Maastricht University, Maastricht, The Netherlands (AdR); Utrecht University, Utrecht, The Netherlands (WS); and Ospedale Universitario San Paolo, University of Milan, Milan, Italy (GI).

Supported, in part, by the Foundation for Research on Intensive Care in Europe (FRICE), Groningen, The Netherlands.

Requests for reprints should be addressed to: Dinis Reis Miranda, MD, PhD, FCCM, Oude Gentweg 14, 8000 Bruges, Belgium. E-mail:

The Nursing Activities Score system is based on the real-time assessment of the duration of nursing activities, independently of the severity of illness of the recipients of care.

© 2003 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins