The Nine Equivalents of Nursing Manpower Use Score (NEMS) is a simplified version of the TISS-28 which can be used in the intensive care unit (ICU) to measure nursing workload. Its development was supported by the Foundation for Research on Intensive Care in Europe and tested in the ICUs of 11 European countries.
|
No. |
Item |
Points |
|
1 |
basic monitoring (hourly vital signs, regular record and calculation of fluid balance) |
9 |
|
2 |
intravenous medications (bolus or continuous infusion, not including vasoactive drugs) |
6 |
|
3 |
mechanical ventilatory support (any form of mechanical or assisted ventilation, with or without PEEP, with or without muscle relaxants) |
12 |
|
4 |
supplementary ventilatory care (breathing spontaneously through endotracheal tube, supplemental oxygen by any method, excludes mechanical ventilatory support) |
3 |
|
5 |
single vasoactive medication: any vasoactive drug |
7 |
|
6 |
multiple vasoactive medications: more than one vasoactive drug, regardless of type and dose |
12 |
|
7 |
dialysis techniques: all |
6 |
|
8 |
specific interventions in the ICU (endotracheal intubation, pacemaker insertion, cardioversion, endoscopy, gastric lavage, emergency operation in the past 24 hours) |
5 |
|
9 |
specific interventions outside of the ICU (surgical operations, diagnostic procedures) |
6 |
from Table 2, page 762
where:
• The points are derived from rounding the calculated B coefficients.
• PEEP = continuous positive airway pressure
• Specific interventions in the ICU does not include routine interventions such as X-rays. echocardiography, electrocardiography, dressing changes, introduction of venous or arterial lines.
• Specific interventions outside of the ICU are related to the severity of illness of the patient and makes an extra demand upon manpower efforts in the ICU.
NEMS =
= SUM(points for items utilized)
Notes on scoring:
(1) The following appear to be mutually exclusive: 3 and 4, 5 and 6
(2) One option would be to score items 8 and 9 for each occurrence; however, based on Figure 1 page 763 the maximum NEMS score does not appear to exceed 56, which it would if each occurrence were scored
Interpretation:
• minimum score: 0
• maximum score (based on the interpretations above): 56
The NEMS correlates with the TISS-28 (see Figure 1, page 763):
estimated NEMS based on TISS-28 =
= 6.7 + (0.76 * (TISS-28 score))
This can be rewritten:
estimated TISS-28 score =
= ((NEMS) - 6.7) * 1.316
Purpose: To use the Nine Equivalents of Nursing Manpower Use Score (NEMS) to quickly assess the demands on nurses caring for a patient in the ICU.
Specialty: Critical Care, Emergency Medicine
Objective: economic cost, public health
ICD-10: ,
