AUSTRALIAN CA~CAL CARE VOL 5 NO 2 JUNE 1992 COSTING NURSING CARE IN CRITICAL CARE Lorraine Ferguson Research Project Manager Sydney Metropolitan Teaching Hospitals Nursing Consortium The health care system in Australia is undergoing many changes, including changes to management information systems, patient classification systems and health care funding arrangements for Area Health Services and hospitals. Using the Diagnosis Related Groups (DRG) patient classification system, and the Yale Cost Model, the Sydney metropolitan teaching hospitals 'can now provide information on the cost of treating particular case types, or patients. Since the nursing budget often represents more than 40% of a hospital's recurrent expenditure, nurse managers need to be able to determine the cost of nursing care per case, or per DRG, to facilitate the planning and budgeting of nursing services. There are a number of methods for costing nursing care, including computerised nursing care plans, and nurse-patient dependency tools. This paper will describe the process of constructing and testing a critical care nurse: patient dependency tool, which will be used as a basis for determining the average cost of care per patient, or per DRG, in the ICU. This project is part of the Sydney Metropolitan Teaching Hospitals Nursing Consortium research project on patient dependency, nursing standards and cost of nursing care per DRG. The project is funded by the Commonwealth Department of Health, Housing and Community Services. CRITICAL CARE OF FULMINANT MENINGOCOCCAL SEPTlCAEMlA Jennifer Graham Intensive Care Unit Westmead Hospital Westmead, NSW Meningococcal (M) Septicaemia at its most fatal is fulminant bacterial sepsis caused by Neisseria Meningitidis. The natural history of children and adults with M. septicaemia will be reviewed. The implications for critical care nurses will be discussed. At Westmead Hospital between 1.1.85 and 16.9.91 there were 36 cases of Meningococcal infection admitted. Three cases were excluded from analysis by the study criteria. Eight cases had M. septicaemia only, of whom 3 died. Of the other 28 patients, 18 had M. meningitis and 7 had both M. septicaemia and M. meningitis. All of these 28 patients survived. These outcomes are consistent with current literature which suggests that M. septicaemia in isolation has the highest mortality. This data will be discussed using some illustrative cases. The patient with fulminant M. septicaemia rapidly develops hypovolaemic shock, cardiac failure, vasculitis and disseminated intravascular coagulation. Treatment is geared to correcting the hypovolaemic shock, supporting the myocardium, antibiotics and correction of metabolic abnormalities. The first 12 hours are critical and generally if the outcome is to be fatal, it will be within this time. Therefore complete nursing and medical assessment at the earliest possible time is vital. This will ensure that the seriousness of the infection is recognised and critical nursing and medical management is promptly instigated to optimise the outcome.

Costing nursing care in critical care

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AUSTRALIAN C A ~ C A L CARE VOL 5 NO 2 JUNE 1992

COSTING NURSING CARE IN CRITICAL CARE

Lorraine Ferguson Research Project Manager Sydney Metropolitan Teaching Hospitals Nursing Consortium

The health care system in Australia is undergoing many changes, including changes to management information systems, patient classification systems and health care funding arrangements for Area Health Services and hospitals. Using the Diagnosis Related Groups (DRG) patient classification system, and the Yale Cost Model, the Sydney metropolitan teaching hospitals 'can now provide information on the cost of treating particular case types, or patients.

Since the nursing budget often represents more than 40% of a hospital's recurrent expenditure, nurse managers need to be able to determine the cost of nursing care per case, or per DRG, to facilitate the planning and budgeting of nursing services. There are a number of methods for costing nursing care, including computerised nursing care plans, and nurse-patient dependency tools.

This paper will describe the process of constructing and testing a critical care nurse: patient dependency tool, which will be used as a basis for determining the average cost of care per patient, or per DRG, in the ICU.

This project is part of the Sydney Metropolitan Teaching Hospitals Nursing Consortium research project on patient dependency, nursing standards and cost of nursing care per DRG. The project is funded by the Commonwealth Department of Health, Housing and Community Services.

CRITICAL CARE OF FULMINANT MENINGOCOCCAL SEPTlCAEMlA

Jennifer Graham Intensive Care Unit Westmead Hospital Westmead, NSW

Meningococcal (M) Septicaemia at its most fatal is fulminant bacterial sepsis caused by Neisseria Meningitidis. The natural history of children and adults with M. septicaemia will be reviewed. The implications for critical care nurses will be discussed.

At Westmead Hospital between 1.1.85 and 16.9.91 there were 36 cases of Meningococcal infection admitted. Three cases were excluded from analysis by the study criteria. Eight cases had M. septicaemia only, of whom 3 died. Of the other 28 patients, 18 had M. meningitis and 7 had both M. septicaemia and M. meningitis. All of these 28 patients survived. These outcomes are consistent with current literature which suggests that M. septicaemia in isolation has the highest mortality. This data will be discussed using some illustrative cases.

The patient with fulminant M. septicaemia rapidly develops hypovolaemic shock, cardiac failure, vasculitis and disseminated intravascular coagulation. Treatment is geared to correcting the hypovolaemic shock, supporting the myocardium, antibiotics and correction of metabolic abnormalities. The first 12 hours are critical and generally if the outcome is to be fatal, it will be within this time. Therefore complete nursing and medical assessment at the earliest possible time is vital. This will ensure that the seriousness of the infection is recognised and critical nursing and medical management is promptly instigated to optimise the outcome.