Nurses' 12-hour shifts and missed or delayed vital signs observations on hospital wards: retrospective observational study
Nurses' 12-hour shifts and missed or delayed vital signs observations on hospital wards: retrospective observational study
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DOI：
10.1136/bmjopen-2018-024778
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发表时间：
2019-06-01
期刊：
影响因子：
2.9
通讯作者：
Smith, Gary
中科院分区：
文献类型：
--
作者：
Dall'Ora, Chiara;Griffiths, Peter;Smith, Gary
目的急性病房护士12小时轮班工作与护士报告的漏诊率增加有关。本研究旨在测量护士轮班至少12小时与错过护理的客观指标之间的关联：根据病情及时进行生命体征观察-基于监测方案。设计一项回顾性观察性研究，使用2012年3月至2015年3月常规收集的数据。在英国一家大型急性医院设置32个普通住院病房。参与者658 628护理班次嵌套在24069个病房日。结果测量每日延迟和错过生命体征观察的比率。我们重点关注需要至少每4小时进行一次生命体征观察的情况，并测量了每24小时内观察延迟或错过的情况数量。对于每个病房和每一天，轮班模式的特点是从“长”轮班（>= 12小时）每病人一天的护理时间的比例为注册护士和healthcare assistant.Results 99 043次（53%），观察显着延迟，并在81 568次（44%），观察错过。当医疗保健助理的工作时间比例较高时，观察更有可能被延迟（IRR=1.05; 95% CI 1.00 - 1.10）。没有显着的关联被发现有关的比例小时注册护士长shift.Conclusion的工作时间由医疗助理的比例较高的日子是从长shift. Conclusion，延迟生命体征观察的风险较高，这表明较低的工作表现。虽然较长的轮班被认为需要较少的人力资源来维持护士与病人的比例，但如果工作人员的生产力降低，任何好处都可能失去。
Objectives 12-hour shifts worked by nurses on acute hospital wards have been associated with increased rates of missed care reported by nurses. This study aimed to measure the association between nurses working shifts of at least 12 hours and an objective measure of missed care: vital signs observations taken on time according to an acuity-based surveillance protocol.Design A retrospective observational study using routinely collected data from March 2012 to March 2015.Setting 32 general inpatient wards at a large acute hospital in England.Participants 658 628 nursing shifts nested in 24 069 ward days.Outcome measures The rate of daily delayed and missed vital signs observations. We focused on situations where vital signs observations were required at least every 4 hours and measured the number of instances where observations were delayed or missed, per 24-hour period. For each ward and each day, shift patterns were characterised in terms of proportion of care hours per patient day deriving from 'long' shifts (>= 12 hours) for both registered nurses and healthcare assistants.Results On 99 043 occasions (53%), observations were significantly delayed, and on 81 568 occasions (44%), observations were missed. Observations were more likely to be delayed when a higher proportion of the hours worked by healthcare assistants were part of long shifts (IRR=1.05; 95% CI 1.00 to 1.10). No significant association was found in relation to the proportion of hours registered nurses worked as long shifts.Conclusion On days when a higher proportion of hours worked by healthcare assistants are from long shifts, the risk of delaying vital signs observations is higher, suggesting lower job performance. While longer shifts are thought to require fewer staff resources to maintain nurse-to-patient ratios, any benefits may be lost if staff become less productive.