De 'Kritische-zorgsituatie-index' voor het meten van de kwaliteit van zorg en veiligheid van intensive-carepatiënten: bruikbaar, betrouwbaar en valide

To establish the usability, reliability, and validity of the Critical Nursing Situation-Index (CNSI), a list of 84 observable deviations from good clinical care, which could place the patient at risk.

Design

Descriptive.

Method

Instructions from nursing standards and protocols were translated into 84 possible observable deviations from usual care (split over 8 care groups, such as artificial respiration and infusion), selected on the basis of risk and included in the index. A research nurse observed the care provided to patients in January-March 1999 from 07.00 to 18.00 hours, at the Intensive Care Unit (ICU) for adults (30 beds) at the Academic Medical Centre, University of Amsterdam. Patient selection was on a randomised basis using the bed numbers. The ICU nurses were blinded for the index items. Inter-observer agreement (κ) was determined by a staff nurse simultaneously observing 10 patients (840 items). Validity was tested on the basis of the correlation between the amount of time available per patient (≤ versus > 30 min/h) and the number of mistakes observed.

Results

The CNSI was applied 200 times to 83 ICU patients. The time needed to carry out 1 observation (84 items) was 5-10 minutes per patient. The average κ was 0.83 (range 0.70-0.80). The construct validity was expressed in the form of a relative risk whereby less nursing time resulted in more critical situations (higher index score: 1.36 (95 CI: 1.11-1.67)).

Conclusion

The index was highly usable, has good measurement characteristics and provided information about the quality of care provided as well as the safety of patients.