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BackgroundCOVID‐19 is associated with increased nursing workload, therefore a high nurse‐to‐patient ratio would be required.AimTo analyse difference in nursing workload, as expressed with the Nursing Activities Score (NAS), between COVID‐19 patients versus control patients without COVID‐19 disease (NCOVID‐19 group) in an Italian Extracorporeal Membrane Oxygenation (ECMO) centre.Study DesignRetrospective analysis of prospectively collected data, enrolling consecutive patients admitted to a general Intensive Care Unit, between 1st May 2019 and 28th February 2021. A multivariate analysis was then performed to assess if COVID‐19 disease was an independent predictor of higher NAS and to assess which other factors and procedures are independently associated with increased workload.ResultsWe enrolled 574 patients, of which 135 (24%) were in the COVID‐19 group and 439 (76%) in the NCOVID‐19 group. The average NAS was higher in the COVID‐19 group (79 ± 11 vs. 65 ± 15, T = −10.026; p < 0.001). Prone positioning, continuous renal replacement therapy (CRRT) and ECMO were used more frequently in the COVID‐19 group. A higher fraction of patients in the COVID group showed colonization from multidrug resistant bacteria. COVID‐19 group had a higher duration of mechanical ventilation and longer ICU stay. The COVID‐19 diagnosis was independently associated with a higher NAS. Other independent predictors of higher NAS were the use of prone positioning and continuous renal replacement therapy (CRRT). Colonization from multidrug resistant bacteria and ECMO support were not independently associated with higher NAS.ConclusionsThe higher nursing workload in COVID‐19 patients is mainly due to specific procedures required to treat the most hypoxemic patients, such as prone positioning. Colonization with multidrug resistant bacteria and ECMO support were not independently associated with a higher NAS.Relevance to Clinical PracticeHigher workload in COVID‐19 patients was due to specific interventions, such as prone positioning and CRRT, with the related nursing activities, as continuous presence at patient's bed, mobilization, positioning and complex hygienic procedures.

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The aim of this study was to investigate the implementation of an intensive care unit (ICU) diary in an Italian general ICU.Methods: A mixed-methods pilot study was performed, enrolling all patients who received an ICU diary in an Italian ICU during the study period.Results: Study results are presented in 2 sections: (1) diary evaluation and content themes and (2) follow-up program results. Sixty-six patients were assessed for eligibility. Diary administration was possible in 31 patients (47%). The overall diary entries, in 31 analyzed diaries, were 1331, with a median of 25 entries (interquartile range, 16-57 entries) for each diary. Participants' relatives and friends wrote a median of 1.2 (0.3-1.6), and nurses wrote 1.1 (0.8-1.2). Other ICU staff wrote a total of 24 entries (2%). Follow-up results revealed low incidence of delirium detected in only 1 patient at the 7-day visit (3%). The median value of PTSS-10 (Post Traumatic Stress Symptoms) score was 12 (3.5-12) at the 7-day visit, 6 (1.5-12) at 3 months' telephone interview, and 12 (1.5-17) at 6 months' visit.Conclusions: To our knowledge, this is the first Italian report about the introduction of an ICU diary.The diaries were easily implemented in our clinical practice as a "low-cost" initiative. In our study, nurses and participants' relatives and friends wrote a similar number of entries in each analyzed diary. This project could be effective in reducing survivors' delirium and post-traumatic stress disorder and in implementing mutual understanding between clinical staff and relatives during ICU stay.