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- Volume 25, Issue 2, 2009
Southern African Journal of Critical Care - Volume 25, Issue 2, 2009
Volume 25, Issue 2, 2009
Author Nicki FoucheSource: Southern African Journal of Critical Care 25, pp 34 –35 (2009)More Less
This edition of the journal looks at the Therapeutic Intervention Scoring System (TISS) and ventilator-associated pneumonia (VAP). TISS may be used as an indicator for the severity of illness of critically ill patients and to assess the nursing workload with regard to therapeutic, diagnostic and nursing activities. TISS is also used to determine nurse-to-patient ratios and assess current bed utilisation and need in order to provide optimal and appropriate nursing care.
Validity and reliability of the simplified Therapeutic Intervention Scoring System in intensive care units of a public sector hospital in JohannesburgSource: Southern African Journal of Critical Care 25, pp 36 –43 (2009)More Less
Purpose. To introduce the simplified Therapeutic Intervention Scoring System (TISS-28) and to employ the original Therapeutic Intervention Scoring System (TISS-76) and Simplified Acute Physiological Score (SAPS) version II in critically ill adult patients in order to describe the validity and reliability of TISS-28 as a suitable measure of quantifying nursing workload in the adult intensive care units (ICUs) of a public sector hospital in Johannesburg.
Objectives. To describe the profile of patient admissions to the ICUs, to investigate the impact of the patients' profile on the requirements for nursing workload, and to validate the use of the TISS-28 as a measure for quantifying nursing workload in this setting.
Design. A non-experimental, comparative, correlation and prospective two-staged design was utilised to meet the study objectives. Stage I involved face and content validation of TISS-28 by a panel of 6 ICU nurse experts. Stage II involved assessment of concurrent and construct validity as well as inter-rater reliability of TISS-28 using 105 participants drawn from trauma, cardiothoracic and multidisciplinary ICUs. Data necessary for the calculation of TISS-28, TISS-76 and SAPS II were recorded for each patient in the ICU at 24 and 48 hours after admission and in the wards after discharge within 24 - 48 hours. Descriptive and inferential statistics were used to analyse data.
Results. A content validity index (CVI) of 0.93 was found for TISS-28. A significant positive correlation was found between TISS-28 and TISS-76 scores (r=0.7857, p=0.0001). Although the correlation between TISS-28 and SAPS II was significant (p=0.0317), it was small (r=0.2098). A significant intra-class correlation (ICC) was found for the data collected from a sample of patients by the researcher and expert assistant researcher (ICC=0.99; p=0.0001).
Conclusions. The findings support the validity and reliability of TISS-28 and hence its feasibility for use in South African ICUs. Recommendations for nursing education, practice, management and research are proposed.
Author R. GillespieSource: Southern African Journal of Critical Care 25, pp 44 –51 (2009)More Less
Ventilator-associated pneumonia (VAP), defined as pneumonia occurring >48 - 72 hours after endotracheal intubation, is the most common and fatal nosocomial infection of intensive care. Risk factors include both impaired host immunity and the introduction of an endotracheal tube, which contributes to the development of VAP in the critically ill patient. VAP is associated with increased mortality and morbidity, increased duration of mechanical ventilation, prolonged intensive care unit and hospital stay, and increased cost of hospitalisation.
Both the Centers for Disease Control Guidelines and Pugin's Clinical Pulmonary Infection Score (CPIS) criteria note that diagnosing VAP requires a combination of clinical signs, impaired gas exchange, radiological changes and positive microscopy to differentiate an episode of VAP from mere colonisation. In a resource-strapped environment, semi-quantitative analysis of specimens obtained utilising a non-invasive sampling technique is an acceptable option. Specific guidelines have been developed to both prevent VAP and treat it appropriately as soon as possible. The guidelines provide targeted strategies, while additional management of VAP includes the provision of essential care, psychosocial support, ventilatory support, enteral feeding and relevant medication including deep-vein thrombosis prophylaxis, and the prevention of complications. The Care Bundle approach offers an interventional tool to implement strategies specifically directed to the prevention of VAP and the facilitation of a team approach to improving its clinical management. The evidence available presents a strong argument to consider a team approach to reducing the incidence of VAP in our own critical care units.