Acuity levels

[fbmom]

We are attempting to assign acuity levels to our patients,to help with staffing levels. The nurse patient ratios seem to change depending on which nurse is assigned to each team.

It is a 24 bed Telemetry unit which receives pre & post cardiac caths, pre and post EPS procedures, r/o MI's, all the post pulmonary patients, all the vascular surgery patients and all the medical pulmonary patients.

Needless to say we are ridiculously busy 24/7. Admin does not take into account the acuity level of each patient when deciding to send someone home early and conserve resources!!

Our ratios are supposed to be 1:5, just recently decreased from 1:6 but having 2 post ops just transferred out of SICU is much busier than having 2 post cath patients.

Any suggestions will be greatly appreciated

Thanks

[caroladybelle, BSN, RN]

Some places use formulas - preferably set up by a Nursing committee of floor nurses.

For example, since I work with Oncology:

Assigning points based on amount of blood products to be given, amount of IV meds/drips, amount and type of chemo, isolation categories, whether the patient is on tele, TPN/NG tube feeds, complicated dressing changes, 24 hours pre/postop, extra blood draws, etc.

All of those things affect the amount of RN time needed. A leukemic induction patient in nadir will require extra time as they are on 10-20IV meds a day, TPN, IV pain med (for severe mucositis), blood products, maybe tele (for low K+ levels with high dose repletions), and extra followup blood draws. A new leukemic(relatively healthy/not in blast crisis) just starting chemo needs chemo teaching, chemo infusion, a few IV meds. One is weighted much heavier than others.

Chemo/cancer teaching takes more time than reading tele or getting one or two IV meds. IV amphotericin B - may require premeds, extra vital signs, pre and post hydration. Assign points that weight the tasks according to required time.

While cumbersome initially, it requires people to think and justify their ratings and eliminates some of the personal bias.

[snowfreeze, BSN, RN]

Yes please include teaching needs in bold letters. Assign patients by realistic time needed for each specific need. Self care, if they need total care or can clean themselves, half points for assisted areas. Feeding, those that need to be fed are higher acuity than those that need set-up ie strokes that can feed self after food cut up etc. Identified Anxiety should have a very high acuity as those patients are on the call light q5mins and file written complaints when their immediate needs are not met. IVs not titrated and IVs titrated. diabetics with AC and HS blood sugars. respiratory needs, oxygen, bipap, incentive spirometry, trachs, suctioning needs. blood transfusions and patients with output replacement needs ie, NG output replaced with IV fluids calculated per shift. Also, drains, foleys, feeding tubes, dressing changes, and I wish we could also include demanding families.

[fbmom]

Any suggestions for making up the 'formulas'? The day assistany nurse manager & I are trying to come up with the magic formula. Any and all help would be appreciated. Thanks