Fall in one-to-one nursing care of very sick newborns linked to higher death rate

http://www.eurekalert.org/pub_releases/2016-02/b-fio020816.php

Public Release: 9-Feb-2016
Fall in one-to-one nursing care of very sick newborns linked to higher death rate
Provision fell by around a third in England between 2008 and 2012
BMJ

A fall in the provision of one to one nursing care of very sick and premature newborns is linked to a higher death rate in neonatal intensive care, finds research published online in the Archives of Disease in Childhood (Fetal & Neonatal Edition).

The proportion of this type of nursing care provided in neonatal intensive care units fell by around a third between 2008 and 2012, the findings show.

The British Association of Perinatal Medicine (BAPM) recommends one to one nursing care for newborns in neonatal intensive care in the UK, and a ratio of one nurse for every two infants in high dependency units. For infants in receipt of special care, the recommended ratio is 1:4.

Yet few neonatal units have achieved the required staffing ratios.

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Between 2008 and 2012, the proportion of one to one nursing care provided in tertiary level neonatal units fell by a third, from an average of 9% to an average of around 6%.

Similarly, the proportion of infants admitted who received one to one nursing care fell from around 39.5% to just under 36%.

During this period, an average of 4.5 infants out of every 100 (4.5%) in receipt of intensive care, died every month.

The researchers calculated that a 10 percentage point fall in the proportion of intensive care days on which one to one nursing care was provided was associated with a monthly increase in the inpatient death rate of 0.6 per 100 infants (0.6%) in intensive care.

This is an observational study so no firm conclusions can be drawn about cause and effect, and sicker infants are more likely to be provided with one to one nursing care, so are at greater risk of death to start with.

"While these findings support an increase in one to one nursing provision in tertiary level neonatal units, they do not inform us whether a one to one nurse to patient ratio for all intensive care days would have a beneficial effect," the researchers caution.

Nevertheless, they conclude: "We believe the results in this study provide some evidence in support of a one to one nurse to patient ratio in neonatal intensive care in England, in line with BAPM guidelines, and therefore provide increased nursing labour provision on neonatal units in England."

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