A nurse practitioner service in an adult tertiary intensive care unit: A prospective observational evaluation

The intensive care nurse practitioner (NP) role in Australia is not well described, and intensive care NP models of care and activities have not been well reported. An intensive care NP service at an Australian tertiary referral hospital was implemented. This service included six core practice areas: case management, vascular access, procedural sedation, tracheostomy management, intrahospital transport of critically ill patients who required mechanical ventilation, and external ventricular drain removal.

The objective of this study was to describe the activities of an Australian intensive care NP service at an adult tertiary intensive care unit over a 1-year period.

Observational and activity data were prospectively collected for all patients who received treatment or care from an intensive care NP. Data were stored in a specific database and summarised using descriptive statistics.

During the 12-month period, 606 patients received care from the service with 1738 episodes of care. In addition, 20 patients were case managed (equating to 300 h of NP time planning and managing ventilator and tracheostomy weaning), 306 intravascular devices were inserted (complications: 1, 0.3% [95% confidence interval {CI}: 0.08-1.8%]), seven episodes of procedural sedation were administered (complications: 0), 62 episodes of tracheostomy care were provided, 33 external ventricular drains were removed (complications: 1, 3.0% [95% CI: 0.7-16%]), 324 intrahospital transfers were completed (avoidable complications: 0, 0% [95% CI: 0-1.1%]), and 72 episodes of supervision were provided by the NP for other clinicians.

The intensive care NP provided high volumes of advanced practice with low complication rates over a 1-year period. Implementation of an intensive care unit NP service has the potential to have positive impacts on workforce, capacity to train, and patient outcomes.