The Critical Nursing Situation Index for safety assessment in intensive care

Objective: The assessment of critical nursing situations can be a valuable tool in the detection of weak elements in the safety of patients and the qu ality of care in the ICU. A critical nursing situation can be defined as an y observable situation, which deviates from good clinical practice and whic h may potentially lead to an adverse event. The aim of our study was to est ablish the feasibility, reliability and validity of the Critical Nursing Si tuation Index (CNSI) as a tool for assessing the safety and the quality of nursing in the ICU. Design: We described the deviations from standards and protocols in daily I CU nursing care, selected those with an implicit, clear risk for the patien ts and translated them into explicitly observable items. If an item was app licable during observation of the ICU practice, a critical nursing situatio n could be recorded as either true or false. The reliability of the CNSI wa s defined in terms of inter-observer agreement. The validity was assessed b y exploring the relationship between the nursing time available (more or le ss than 30 min per patient per hour) and the incidence of critical nursing situations. Setting: The study was performed in the ICU of a teaching hospital (30 IC b eds) in which all disciplines, including cardiothoracic surgery and neurosu rgery, were represented. Patients: The CNSI was randomly applied to 83 ICU patients over a period of 3 months (200 times). Measurements and results: The reliability of the index was substantial (Kap pa values in the range greater than or equal to0.70 to > 0.80). In terms of validity, less nursing time resulted in more critical situations (pooled r elative risk (RR) 1.36; 95% confidence limits 1.11/1.67). Conclusion: The CNSI is simple to use and has encouraging metric properties , whereas the assessments are closely related to direct patient care. Moreo ver, the CNSI provides a tool for safety assessment by monitoring potential ly dangerous situations that are generally regarded as needing to be avoide d.