How Is Your ICU/CCU Tracking Acuity?

[danegerous, BSN, RN]

Hello fellow nurses, I have a quick question that will probably lead to a not-so-quick answer.

I have recently been put in charge of keeping track of and finding a useful way for utilizing acuity data on both our ICU and CCU floors. As you may know (or maybe it's only in IL) hospitals and the units within them are required by law to keep track of the acuity of the patients to ensure proper staffing.

The idea on the Med/Surg and Tele floors is to simply fill out a form for each patient at the end of your shift detailing certain therapies. There are five categories: ADLs, Monitoring, Medications, Interventions, and Teaching/Behavior/LOC.

Within each of these categories are 6-7 "ratings" that the nurse is to circle stating the level of care required in that particular category. For instance, under medications the ratings: 1 - PO/IM meds, 2 - 1 IV drip and/or multiple meds, 3 - 1-2 stable IV drips and/or multiple IV meds, 4 - Medications every 1-2 hours, 5 - Medications more often than every hour; IV drips with minimal titration, 6 - IV drips with unstability requiring titration.

So, the nurse then circles the level of care for the meds section. At the end of the sheet, the nurse tallies the total and assigns it a final "level". Level 1: >28 points, Level 2: 19-27 points, Level 3: 10-18 points, Level 4: 6-9 points. With these final scores, the manager and supervisor can figure out how many patients a Tele or Med/Surg nurse can get, and the acuity of those patients.

So, it makes sense for those particular units to keep track like this, since they can have anywhere from 3-10 patients (I know, 10!). However, for ICU/CCU this is unpractical. We have 10 beds per unit, not 48. Our charge nurses are very well-tuned to the acuity of the patients and thus are great at dividing up teams. But legally, we need to keep track of this. This brings me to my question, how do you do it in your ICU/CCU? How do you keep track of the level of difficulty of your patients to ensure safe nursing and efficient workloads?

In the same way, once this acuity method is developed, we can implement a rock solid method for transferring patients to ICU. Currently, if the Doc says transfer, they're transferred. If ER says the word, they get transferred. So, there is no real rubric for what really is and ICU patient.

Any and all help is totally appreciated! Please share any and all ideas, even if they don't work, those will help too!

Thanks!

Dane

[HiHoCherry-O]

The ICU I work in uses WinPFS to track acuity levels. It sounds just like what you described for the MedSurg and Tele floors except ours is done on the computer.

Good luck.

[NicuGal, MSN, RN]

We use the win one too...but it is flawed, as are all of them. Most of our vent kids get the same score as a kid who is feeding.

[danegerous, BSN, RN]

As a quick update, I have been researching practically my whole night (thank God we don't currently have an acuity tool and I got landed with two tele-grade patients, haha). I have been really looking into the TISS-28 questionnaire. I have typed it all up and begun editing/ammending certain points and adding my own. I will be checking with all the nurses on the unit to ensure a) that I didn't forget anything and b) that I didn't artificially inflate the numbers with extra data. The thing is, the TISS-28 as it was developed is for an 8-hour shift. In order to make it fit a 12 hour shift, I will need to do a little more consulting. Even though the output is in minutes, not some other random integer, it still needs a little bit of tweaking.