Determination of TISS in an individual patient

Data are collected from the previous 24 h, preferably at the same time each day and by the same observer, and the score is tallied. Since some interventions are interrelated, only the highest point intervention is scored. For example, if within a 24-h period a patient received controlled ventilation (4 points) and then was weaned to intermittent mandatory ventilation (3 points), continuous positive airways pressure (3 points), and spontaneous ventilation with supplemental oxygen (1 point), the 4-point intervention (for controlled ventilation) is scored but not the others. As patient status improves, interventions are usually withdrawn and TISS decreases. Conversely, as severity worsens, therapy escalates and TISS points increase.

Although not essential, we recommend that TISS data collectors have a critical care nursing background. Such nurses can easily identify the interventions and evaluate the appropriate associations within and between categories. Once familiar with the tool, an experienced observer can assign interventions and tally points in 3 to 5 min per patient. Table 1. can serve as the data collection instrument.

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