acuity based staffing ratio

Our unit uses an acuity tool that doesn't really capture much. I don't know what it is because we mere frontlines nurses aren't permitted to have any input into the scoring of our patients. The night charge nurse, who may have gotten report from a day charge nurse who has no clue what's going on at half the bedsides, fills it out late in the evening. It seems to have no bearing on our staffing at all.

We use a system called WinPFS. It is an Acuity, Productivity and Benchmaking system. I am not sure how they came up with the numbers that are assigned to the diffrent sections but for us it is pretty close to what we staff. We use it as a guidline, not an absolute. As far as your hearts being one to ones, ours are. Most of them for 24 hours. Our acutiy system does capture that. I am not sure where you are practicing. I am in CA.

I worked in a hospital that used the PRN system of assessing acuity. There were dozens of criteria that when added up gave a score for the patient. It took the bedside nurse about five minutes to run through the list and circle all the interventions the patient would need for 24 hours, add up the cumulative scores then pass it on to the unit secretary to enter into the computer. It seemed to capture the essence of caring for each patient and gave the administration a clear indicator of how busy each patient would be. Of course, it got tossed out like yesterday's newspaper and staffing went to Hades.

In our unit, the charge nurse constantly gets updates on every patient to plan for the next shift, so if the patient was stable overnight, but became really busy during the day, they can plan to make the pt. a 1:1 for the next shift. For the most part, oscillated patient, and surgical CV patients are always 1:1. We have an 18 bed unit and have at least 10 nurses scheduled per shift.

We have developed our own acuity system. We used the old TISS as a baseline, then formulated our own points, etc. Have revised it about 3-4 times, so it is still a work in progress. It seems to be a little more objective though than before. Our manager felt that is pt wasn't on at least 2 pressors then they didn't need to be 1:1. We all felt many pts are busy in other ways that are not necessarily on multiple drips.
Kathy

I don’t work in picu, but I have used the GRASP methodology in Surgical Intensive Care. The workload is measured at the intervention level so details such as the needs of a one to one patient are identified. My experience is that the staffing office wants the total requirements, but the manager wants details! So far we have been lucky and they do staff to what the system shows we need – or at least as best they can with the staff that is available. You might try their website www.graspinc.com