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0 I've been casually working to create a tool for objectively measuring and classifying the current and anticipated acuity levels of the patients on my unit. I know that peoples' definitions of what constitutes a high acuity patient may differ vastly based upon numerous factors, and I don't want to create something that reflects only what I consider acuity to entail. I'm interested in hearing what other nurses believe influences a patients acuity, whether it is objective or subjective, or pertaining to the level of skill required, physical demand, knowledge, time consumption, a particular diagnosis, patient condition. whatever springs to mind when YOU think of acuity! It doesn't matter if you have evidence or an explanation to support your ideas, any input would be greatly appreciated.
About annister. RN
Staffing by acuity has two dimensions to it; acuity of medical condition and time consumption acuity. You'll find many definitions of staffing by acuity, such as that used by Magnet, to be only based on medical condition, which is really insufficient when trying to implement an acuity system to help guide staffing.
Medical acuity only takes into account medical diagnoses, and the severity/stability of those diagnoses. What that misses is that there can be huge differences in staffing requirements for the same medical acuity. Take two patients with a stable (not currently bleeding) lower GI bleed who are doing prep overnight for a colonoscopy in the AM (same medical acuity). One is 35, otherwise healthy, and fully ambulatory. The other is 375 pounds and a 2+ person assist to the commode. Those q 30 minute to 1 hour trips to the
commode would require many more staff hours for patient 2 than patient 1, which really needs to be reflected in assessing staffing needs. In the end, whether or not I am having to spend and extra hour dealing with a complex medical situation, or helping a person to the commode over and over again, it's still an extra hour.
The main difference between medical acuity and labor time acuity is that a higher medical acuity requires more RN time, whereas a higher labor time acuity can be offset with either more RN's or CNA's.
I took this on as a project as well when I was on a tele floor. I found there are acuity rating systems out there (for purchase) that ask a series of questions and then give patients an acuity score. But what I found was that they just give a score of 1,2, or 3. It shouldn't take 2 pages of forms to come up with a score of 1,2 or 3, so we just came up with some basic definitions of each score and added another qualifier which is that 2 or 3 could be designated "RN intensive", meaning the patient was more of a higher medical acuity which would need to be reflected in the staffing.
As you point out, the advantage to this is not only to help make sure that the floor is staffing up when needed, but everyone knows who the busy patients are and what nurses have a heavier load than others and may need help (as well as which nurses have a lighter load and should offer help-which can also cause some problems).