Méd. Intensive Réa., avril 2018 ; 27 : 273-278
BACKGROUND: Any act completed by a French nurse outside their defined competence (French Public Health Code—29/07/2004) has to be considered as an out of scope event (OSE). In a first survey, done in 2016, in the AtlanRéa Intensive Care Unit (ICU) Group (AtlanRéa Group = West of France ICU Clinical Research Association), 94% of respondent nurses admitted doing at least one OSE a day. We investigated this prevalent problem, as a nurse’s source of concern. The survey was made on March 7, 2017.
MATERIALS AND METHODS: An online survey comprising ten multiple choice questions and free space for comments was deployed, followed by phone contact to explain the process. Questions were about unit demography, ICU type, staff, working time, medical attendance, and OSE quantity, type, circumstances, and protocol existence, risk perception, and finally proposed solutions. The statistics involved was descriptive, in percentages, median and interquartile 1 and 3. The data was analyzed using univariate analysis by parametrical tests (Chi2), P < 0.05 significant. We collected 526 questionnaires in 94 ICU from 36 counties. We retrospectively estimated the potential participants’ number at 1500, assuming response rate of 35%. The distribution was as follows: 57% in university hospitals, 43% in general hospitals; median diploma year was 2009 [2004–2013], median seniority was 5 years [2–8].
RESULTS: 63% of respondents declared performing OSE, 23% of them more than 5 a day. OSE was about FiO2 modification for 52% of respondents, sedation bolus administration (47%), and ventilator settings modification (41%). The main reasons were: patient comfort (71%), unit’s habit (63%). There was a difference of OSE frequency between university hospitals and general hospitals (69 vs. 59%; P = 0.019). Risk perception for the patient was 64% and 89% for the caregiver. Preferred solutions to decrease OSE were: ICU specialization for nurses (75%) and defined skills update (54%).
CONCLUSION: We report for the first time, national data about OSE in the ICU setting. The main goal is patient comfort. Our findings highlight the need for changes. Specialization in ICU for nurses is mandatory as well as actual implementation of existing laws. A survey among ICU physicians would specify what kinds of skills are expected from such specialized nurses.