Preliminary results on nursing workload in a dedicated weaning center

Objective: To evaluate the nursing time required for difficult-to-wean pati ents in a dedicated weaning center (WC) and to examine the correlation of t he nursing time with nursing workload (NW) scores and with clinical severit y and dependency. Setting: Four-bed WC of a pulmonary rehabilitation department. Intervention: None. Design and measurement: Prospective, observational study of 46 consecutive patients admitted to a long-term WC. Time required by items of the Time Ori ented Score System (TOSS) and other tasks specific to respiratory intermedi ate intensive care units were evaluated for all the activities performed on each patient in the first 2 days after admission. Patient dependency and l evel of nursing care at admission were measured using the Dependence Nursin g Scale (DNS) and the Intermediate Therapeutic Intervention Score System (T ISS-int). The Acute Physiology and Chronic Health Evaluation (APACHE) II sc ore was also recorded at admission. Results: On the first day each patient needed 45 +/- 15 % (63 +/- 23 %, 45 +/- 22 %, and 29 +/- 14 % for the three nursing shifts) of allocated single nursing time. On the TOSS on the first day patients required a daily mean 28 +/- 10 % of total available nursing time; on the second day the results did not change. Time of care in the first 24 h was only weakly related to D NS, APACHE II score, and TISS-int; only DNS was able (although weakly; r = 0.45) to predict minutes of nursing care. Conclusions: In difficult-to-wean patients from mechanical ventilation the nursing time in the first 2 days after admission is high. The use of TOSS m ay underestimate NW by about 38 %. Although only DNS showed the ability to predict minutes of care, the weak relationship limits its value in clinical practice.