The Impact of under-Staffing of Nurses on Sedative/Analgesic Agents Administration in Pediatric Intensive Care Unit [PICU]

Institution: Department of Pediatrics, pediatric critical care, University of Buffalo Oishei Children’s’ hospital. Objective: To evaluate the impact of understaffing on administration of sedatives and analgesics to patients in pediatric intensive care unit [PICU]. Design: Retrospective cohort. Setting: PICU in a university-affiliated children’s hospital. Patients: Fifteen intubated children 0-21 years of age admitted to the PICU in September and October 2017 at the Women’s and Children’s Hospital of Buffalo. Twenty-one intubated children admitted in January and February 2018 at Oishei Children’s Hospital. All intubated patients in our study received sedation and analgesic drips and/or boluses. Intervention: None. Results: We used NEMS [Nine Equivalent of nursing use Manpower score] as a way of evaluating the ‘appropriateness’ of nurse-patient ratio. Appropriate shifts were defined as shifts with Nurse/Patients [N/P] ratio similar to that determined per NEMS. Under-staffed Shifts were shifts with N/P ratio less than determined per NEMS. Sedation burden was defined as extradoses of sedation given or rate change of drip per shift. There were no differences in age, sex, race, weight and PRISM score between patients admitted in both hospitals. There was no significant difference in sedation burden between appropriate shifts 207/429 [48.2%] vs under-staffed shifts 26/44 [59.1%], p-value=0.17. Linear regression was used to account for severity of disease using PRISM score, there was no significant difference between the two groups. There was significant sedation burden in shifts with higher N/P ratio [1:1 or 2:1] vs lower N/P ratio [1:2] [112/191 58.6% vs 121/281 43%, p-value=0.0009]. Conclusion: We could not prove that understaffing would be associated with increase sedation. In our study group, there was increase sedation administration to patients when they had more nurses at their bedside. We think having an established sedation score and collecting these scores with the amount of sedation given during appropriate and under-staffed shifts might help controlling for some of the variables and give a more objective method to judge the patients’ depth of sedation. More studies need to be conducted on the effect of nurse staffing and the amount of sedation.