Charge en soins (NEMS)
Charge en soins (NEMS)
Ce score (appelé aussi TISS simplifie) permet de calculer tres facilement la charge en soins journaliere

Monitorage de base
signes vitaux horaires, bilans entrées-sorties		 9
Médicaments intraveineux (sauf drogues vaso-actives)
administrés en bolus ou en continu		 6
Ventilation mécanique
toute forme de ventilation assistée ou mécanique		 12
Autre prise en charge ventilatoire
VS sur tube ou toute autre méthode d'oxygénation sauf mécanique		 3
Une seule drogue vaso-active
quelque soit la drogue		 7
Plusieurs drogues vaso-actives
plus d'une drogue vaso-active, quelque soit la drogue et la dose		 12
épuration extra rénale
toutes les techniques		 6
Interventions spécifiques à l'intérieur de la réanimation
e.g. intubation endo-trachéale,
pose d'une sonde d'entraînement electrosystolique,
cardioversion, endoscopies,
chirurgie urgente dans les 24 dernières heures,
lavage gastrique...		 5
Interventions spécifiques en dehors de la réanimation
e.g. interventions chirurgicales, procédures diagnostiques		 6
Total NEMS points



Pour en savoir plus:

Reis Miranda DR, Moreno R, and Iapachino G. Nine equivalents of nursing manpower use score (NEMS). Intensive Care 1997; 23 : 760-765.

OBJECTIVES: To develop a simplified Therapeutic Intervention Scoring System(TISS) based on the TISS-28 items and to validate the new score in anindependent database. DESIGN: Retrospective statistical analysis of a databaseand a prospective multicentre study. SETTING: Development in the database ofthe Foundation for Research on Intensive Care in Europe with externalvalidation in 64 intensive care units (ICUs) of 11 European countries.

MEASUREMENTS AND RESULTS: Development of NEMS on a random sample of TISS-28items, cross validation on another random sample of TISS-28, and external validation of NEMS in comparison with TISS28 scored by two independent raterson the day of the visit to the ICUs participating in an international study.

Multivariable regression techniques, Pearson's correlation, and paired sample t-tests were used (significance at p < 0.05 level). Intraclass correlation, rate of agreement, and kappa statistics were used for interrater reliability tests. The TISS-28 items were reduced to NEMS (9 items) in a random sample of 2000 records; the means of the two scores were no different: TISS-28 26.23 +/- 10.38, NEMS 26.19 +/- 9.12, NS. Cross-validation in a random sample of 996 records; mean TISS-28 26.13 +/- 10.38, NEMS 26.17 +/- 9.38, NS; R2 = 0.76. External validation on 369 pairs of TISS-28 and NEMS has shown that the means of the two scores were no different: TISS-28 27.56 +/- 11.03, NEMS 27.02 +/- 8.98, NS; R2 = 0.59. Reliability tests have shown an "almost perfect" interrater correlation. Similar to studies correlating TISS with Simplified

Acute Physiology Score (SAPS)-I and/or Acute Physiology and Chronic Health Evaluation II scores, the value of NEMS scored on the first day accounts for 30.4% of the variation of SAPS-II score. CONCLUSIONS: NEMS is a suitable therapeutic index to measure nursing workload at the ICU level. The use of NEMS is indicated for: (a) multicentre ICU studies; (b) management purposes in the general (macro) evaluation and comparison of workload at the ICU level; (c) the prediction of workload and planning of nursing staff allocation at the individual patient level.