Safety as a criterion for quality: The Critical Nursing Situation Index in paediatric critical care, an observational study

The Critical Nursing Situation Index (CNSI) identifies deviations from safe practice as laid down in guidelines, using an observational approach. The CNSI contains a list of predefined items that stem from nursing protocols and guidelines. Deviation from these may lead to adverse events and compromise the safety of the patient. To prevent and reduce nursing error we applied the “Critical Nursing Situation Index” in the Paediatric Intensive Care Unit (PICU). Prospective observational study. A 12-bed PICU of an academic university teaching hospital in the Netherlands. Out of 7147 items at risk we observed 1285 critical situations. The overall incidence of critical situations resulted in 18 per 100 items at risk. No correlation was found with effective time of direct patient care. Workload showed a significant correlation (Pearson's r .278; p = .001). In every day PICU practice an unknown set of nursing situations exist, carrying the potential for the occurrence of an adverse event. The CNSI may be a valuable tool in analysing the incidence of these situations. The CNSI is a practical instrument used to quantify and analyse the frequency of potential nursing errors. It focuses on identifying events that could reduce patient's safety, before harm occurs.