|
Monitoring and control
|
|
|
- Vital time savings, calculation and regular recording of the water balance.
Patients are considered to be stable from a respiratory, neurological and hemodynamic point of view and perform routine checks. Vital signs of specific drugs that may be cardiotoxic or hypotensive, such as paclitaxel and etoposide, and in blood transfusions.
|
4.5 |
100 |
- Presence at the bedside and observation or continuous activity for 2 hours or more in any shift for safety, severity or therapy reasons such as: non-invasive mechanical ventilation, weaning, restlessness, mental confusion, prone position, donation procedures of organs, preparation and administration of fluids or medication and aid in specific procedures.
It is considered a patient specifically receives antineoplastic antibiotic, pain evaluation, environment/comfort, anxiety, temperature control, cardiac monitoring, daily weight assessment, difficult venous access, administration of irritants or blister agents, which require direct supervision, salinization of catheters and follow-up of biopsies performed at the hospitalization unit.
|
12.1 |
100 |
- Presence at the bedside and observation or continuous activity for 4 hours or more in any shift, for reasons of safety, severity, therapy, such as the examples above.
Patients are considered to be those need extravasation of antineoplastic antibiotics (blister agents), patients with hemodynamic instability or immediate and exacerbated effects of chemotherapy, transfusion reactions. Fatigue, peripheral neuropathy, hands and feet syndrome, anorexia, nausea/vomiting, anxiety and among others are adverse reactions of chemotherapy.
|
19.6 |
85.7 |
|
Laboratory investigations
|
4.3 |
71.4 |
- Biochemical and microbiological
Platelet counts, erythrocytes, leukocytes, neutrophils check and search for tumor markers in possible relapse/disease progression and collection (feces, urine, secretions and cultures).
|
|
Medication - except vasoactive drugs |
|
|
|
Any type of drug, psychotropic, antineoplastic antibiotics, irritants and blisters, monoclonal antibody, antiemetics and opioids, except vasoactive drugs, antibiotics, antifungals, growth factors, interferon, chemotherapy installation regardless of frequency and amount or way of administration.
|
5.6 |
100 |
|
Hygiene proceduress
|
|
|
- Carrying out hygiene procedures, such as: changing wound dressings, changing bedding, patient hygiene in special situations (incontinence, burns, secreted wounds, complex surgical dressings with irrigation) and special procedures isolation).
Patients are considered to be those with skin lesions (oncological or not) and/or surgical incision, intravenous catheters (short and long term), ostomy care (exchange of pouch, dressing and skin care), dressing change, emesis of implantable or semi-implantable or peripheral central catheter dressing, eg Port-a-Cath or Hickman, Broviac, Intracath and PICC.
|
4.1 |
100 |
- Carrying out hygiene procedures that last more than 2 hours in any shift.
Patients are considered to be those present acute emesis and/or diarrhea with or without bleeding, contact precaution, droplets and aerosols.
|
16.5 |
100 |
- Carrying out hygiene procedures that last more than 4 hours in any shift.
Patients are considered to be those present late emesis and/or diarrhea with or without bleeding.
|
20.0 |
100 |
| Care with drains - all of them (except gastrostomy tube) |
1.8 |
100 |
|
Mobilization and positioning
|
|
|
| Including procedures such as: change of position, patient mobilization; transfer of the bed to the chair, mobilization of the patient with the team (e.g, immovable patient, traction, prone position). |
- Performing the procedure (s) up to 3 times by nursing professional within 24 hours.
Patients are considered to be those needs help to move, get out of bed, help in positioning to feed, etc.
|
5.5 |
100 |
- Performing the procedure (s) more than 3 times or with 2 nursing professionals, at any frequency, within 24 hours.
Patients are considered to be those need mechanisms for positioning (ramp, bed sheet, restraint, bed transfer).
|
12.4 |
100 |
- Performing the procedure (s) with 3 or more nursing professionals, at any frequency, within 24 hours.
Patients are considered to be those need mechanisms for positioning (ramp, sheet, restraint), who are under the effect of drugs of the sedative or opioid type, and who are obese, elderly and/or bedridden.
|
17.0 |
100 |
|
Support and care for family and patients
|
|
|
Including procedures such as phone calls, interviews and counseling.
Frequently, support and care, either to the family or to the patient, allow the team to continue with other nursing activities (e.g, communication with the patient during hygiene procedures and communication with relatives, while at the bedside observing the patient, clarification as to the procedures to be performed by the team, presentation of the unit, norms and routines to the patient and their relatives).
|
- Support and care for family members and patients who require exclusive dedication for about an hour on any shift, such as: explaining clinical conditions, coping with pain and distress, and coping with difficult family circumstances.
Patients and their families are considered as those present anxiety and/or doubts of the patient in the face of therapy or fear of death, as well as the expectations of their relatives regarding their treatment. Request psychological counseling or a Palliative Care team (when evaluated by the physician and requested by him, consisting of nurse, psychologist, physician, social worker and chaplain (to punctuate only the request).
|
4.0 |
85.7 |
- Support and care for family members and patients require exclusive dedication for 3 hours or more in any shift, such as: death, difficult circumstances, such as large numbers of family members, communication failures, hostile family members.
Patients are considered to be those initiate treatment and receive guidance on the diagnosis, treatment and course of the disease, and in situations of extreme anxiety of the patient and family, in which a greater dedication and clarification is required. Nurses qualified in end-of-life care, communication of bad news.
|
32.0 |
85.7 |
|
5. Administrative and managerial tasks
|
|
|
- Performance of routine tasks, such as: processing clinical data, requesting exams, exchange of professional information (eg, shifts and clinical visits).
It is considered the application of the Nursing Process or protocols that last up to 1 hour in a continuous or fractional way. For Example: Sepsis Protocol.
|
4.2 |
100 |
- Perform administrative and managerial tasks that require full dedication for about 2 hours on some shift, such as: research activities, protocol application and admission and discharge procedures.
Administrative procedures are considered to transfer the patient to another institution or institution, to report on occurrences, such as the management of extravasation and/or referral of specific tests, to meet the demand of the insurers - reports, justification of glosses, among other details.
|
23.2 |
100 |
- Performance of administrative and managerial tasks that require full dedication for about 4 hours or more on any shift, such as: death and organ donation procedures and coordination with other disciplines.
It is considered the holding of multiprofessional clinical meetings, consensus meeting and monitoring of the Permanent Education activities of the team.
|
30.0 |
100 |
|
Ventilatory support
|
|
|
| 6. Ventilatory support - presence of any form of mechanical ventilation/assisted ventilation with or without positive end-expiratory pressure, with or without muscle relaxants, spontaneous breathing with or without positive end-expiratory pressure (ex-CPAP or BiPAP), with or without endotracheal tube, supplemental oxygen, or any method.
|
1.4 |
100 |
7. Care with artificial air passages -endotracheal or tracheostomy tube.
Special care is provided for patients with lesions in the nasal and oral cavities and docketed care such as oral mucositis and dentists' request in general or in specific care, such as in bone marrow transplantation.
|
1.8 |
100 |
8. Treatment to improve pulmonary function - physiotherapy, stimulated spirometry, inhalation therapy, endotracheal aspiration.
It is considered the accomplishment of the tracheal aspiration and request of accompaniment of physiotherapists (to punctuate the request).
|
4.4 |
85.7 |
|
Cardiovascular Support
|
|
|
12. Dosage-independent vasoactive medication.
Patient is considered to be those who receive chemotherapy drugs with allergenic potential and monoclonal antibodies (e.g, avastim, transtuzumab). Installation and constant change of chemotherapeutic and administration of fluids for hydration, depending on the drug administered. Patients undergoing cardiotoxic drugs, such as Doxorubicin, Fluorouracil and Cyclophosphamide.
|
1.2 |
71.4 |
13. Intravenous replacement of large fluid losses, fluid delivery> 3 l/m2/day, regardless of the type of fluid administered.
Patients are to be considered those receive fluid replacement like the crystalloids, colloids, blood and blood derivatives routinely.
|
2.5 |
100 |
| 14. Monitoring of the left atrium. Pulmonary artery catheter with or without cardiac output measurement.
|
1.7 |
100 |
| 15. Cardiorespiratory resuscitation in the last 24 hours, excluding precordial thump. |
7.1 |
100 |
|
Renal Support
|
|
|
16. Hemophilization and dialytic techniques
It is considered the request of any dialysis modality: continuous peritoneal dialysis or intermittent peritoneal dialysis. In both cases of renal replacement therapy with any duration (the request being punctuated if not performed in the unit).
|
7.7 |
100 |
17. Quantitative measure of oliguria.
Patients are considered to be undergo urinary volume control through spontaneous urination, long-term or short-term bladder catheter, diaper or sheet weight. Methotrexate, serious magnesium levels (e.g, asparaginase, vincristine and ifosfamide) and in case of nephrotoxic drugs (e.g, cisplatin and interleukin 2).
|
7.0 |
85.7 |
|
Neurological Support
|
|
|
18. Measurement of intracranial pressure.
Patients are considered to be those receive intrathecal chemotherapy and who had bleeding due to thrombocytopenia.
|
1.6 |
85.7 |
|
Metabolic Support
|
|
|
19. Treatment of acidosis/complicated metabolic alkalosis.
Patients are considered to be those are in metabolic emergencies, such as acute or chronic hypercalcemia, tumor lysis syndrome, hyperglycemia, septic shock and ascites.
|
1.3 |
100 |
20. Intravenous hyperfeeding.
Patients are to be considered those receives parenteral nutrition.
|
2.8 |
100 |
21. Enteral feeding through a gastric tube or other gastrointestinal tract (e.g, jejunostomy).
Patients are to be considered those with enteral diet.
|
1.3 |
100 |
|
Special Interventions
|
|
|
22. Specific interventions in the ICU: endotracheal intubation, pacemaker insertion, cardioversion, endoscopy, emergency surgery in the last 24-hour period, gastric lavage. Routine interventions without direct consequences for the clinical conditions of the patient, such as: x-rays, ultrasound, electrocardiogram, dressings or insertion of venous or arterial catheters, are not included.
It is considered a unit of nursing care and ICU the passage of nasoenteric, vesical, probes, assistance to physicians in myelogram, thorocentesis, collection of liquor and intrathecal medication, PICC (central venous catheter for peripheral insertion), marrow biopsy, pericardiocentesis and Oncologic Emergencies (e.g superior vena cava syndrome, spinal cord compression, among others).
|
2.8 |
71.4 |
23. Specific interventions outside the ICU: diagnostic or surgical procedures
Nursing care unit is considered if there is an ICU including units of Bone Marrow Transplant. Patient follow-up and transfer, examinations, treatments such as radiotherapy and intravenous catheter.
|
1.9 |
100 |
