Therapeutic Intervention Scoring System used in the care of patients in pentobarbital-induced coma to determine nurse-patient ratios.
BACKGROUND
Critical care patients generally require extensive interventions, thereby consuming a large percentage of healthcare resources. Induced pentobarbital coma for the management of increased intracranial pressure is one such intervention, required to maintain patient stability. Quantification of these interventions, as well as the amount of nursing work required, has not been addressed in the literature.


OBJECTIVE
To use the Therapeutic Intervention Scoring System to analyze and quantify how interventions affect nurse-patient ratios in the management of patients in pentobarbital coma for refractory increased intracranial pressure.


METHODS
The medical records of patients with subarachnoid hemorrhage from aneurysmal rupture and subsequent increased intracranial pressure, in whom pentobarbital coma was salvage therapy, were reviewed retrospectively. The Therapeutic Intervention Scoring System was used to quantify the number of interventions required before, during, and after coma induction. The data were analyzed and daily Therapeutic Intervention Scoring System scores correlated with serum pentobarbital levels. Typically, a critical care nurse can manage a patient caseload of 40 to 50 Therapeutic Intervention Scoring System points. By quantifying the interventions, the score reflected the amount of care required to manage the patient in barbiturate coma.


RESULTS
The intensity of interventions correlated with the level of coma, length of time in coma, and associated complications.


CONCLUSIONS
The scores indicated the intensity of interventions used in pentobarbital coma and the use of resources. Nursing care and complications involved with this therapy were quantified and nurse-patient ratios were established.
Myles
G L
GL
Department of Neurology, St Louis University Health Sciences Center, MO, USA.
Malkoff
M D
MD
Perry
A G
AG
Bucholz
R D
RD
Gomez
C R
CR
D000328:Adult; D002561:Cerebrovascular Disorders / Q000188:drug therapy / Q000209:etiology / Q000451:nursing; D003128:Coma / Q000145:classification / Q000451:nursing*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007427:Intracranial Pressure; D008297:Male; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000600:supply & distribution*; D010424:Pentobarbital / Q000627:therapeutic use*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000451:nursing; D016526:Workload
D006993:Hypnotics and Sedatives; D010424:Pentobarbital