title: High accuracy of the nine equivalents of nursing manpower use score assessed by critical care nurses.
abstract: BACKGROUND
  The nine equivalents of nursing manpower use score (NEMS) is frequently used to quantify, evaluate and allocate nursing workload at intensive care unit level. In Switzerland it has also become a key component in defining the degree of ICU hospital reimbursement. The accuracy of nurse registered NEMS scores in real life was assessed and error-prone variables were identified.
  
  
  METHODS
  In this retrospective multicentre audit three reviewers (1 nurse, 2 intensivists) independently reassessed a total of 529 NEMS scores. Correlation and agreement of the sum-scores and of the different variables among reviewers, as well as between nurses and the reviewers' reference value, were assessed (ICC, % agreement and kappa). Bland & Altman (reference value - nurses) of sum-scores and regression of the difference were determined and a logistic regression model identifying risk factors for erroneous assessments was calculated.
  
  
  RESULTS
  Agreement for sum-scores among reviewers was almost perfect (mean ICC = 0.99 / significant correlation p <0.0001). The nurse registered NEMS score (mean ± SD) was 24.8 ± 8.6 points versus 24.0 ± 8.6 points (p <0.13 for difference) of the reference value, with a slightly lower ICC (0.83). The lowest agreement was found in intravenous medication (0.85). Bland & Altman was 0.84 ± 10, with a significant regression between the difference and the reference value, indicating overall an overestimation of lower scores (≤29 points) and underestimation of higher scores. Accuracy of scores or variables was not associated with nurses' characteristics.
  
  
  CONCLUSIONS
  In real life, nurse registered NEMS scores are highly accurate. Lower (≤29 points) NEMS sum-scores are overestimated and higher underestimated. Accuracy of scores or variables was not associated with nurses' characteristics.
authors.affiliation: Intensive Care Unit, Department of Intensive Care - Ente Ospedaliero Cantonale, Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland. andreas.perren@eoc.ch
authors.forename: Andreas
authors.initials: A
authors.lastname: Perren
authors.forename: Marco
authors.initials: M
authors.lastname: Previsdomini
authors.forename: Ilaria
authors.initials: I
authors.lastname: Perren
authors.forename: Paolo
authors.initials: P
authors.lastname: Merlani
mesh_terms: D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D009729:Nursing; D009741:Nursing Staff, Hospital / Q000706:statistics & numerical data*; D015588:Observer Variation; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013557:Switzerland; D000078329:Workforce; D016526:Workload