Explanation of an Acuity System

[bamanurse]

i am a nursing student, and was given an assignment on acuity systems. i need to know the definition of acuity and also how the system works. i would like to have several responses for my report. any information would be very appreciated!!

[begalli]

Here is an example of a very basic Patient Classification System (PCS). It is a system that measures patient needs and nursing care required to meet those needs. It includes the severity of the patient's illness and complexity of clinical judgement needed by the RN to take care of the patient.

This measurement is also known as patient "acuity" and filling in the blanks with information about the patient results in a "score" which determines the number of staff required by skill level and patient need based on the resulting patient classifications.

PCS's are required by law in CA. I don't know about other states?

Our system is a bit more intense and includes specific interventions and places a time allotment for the interventions than the PCS in the link I provided above. The more time intensive a patient is, the higher that patient's score. So for example, if a patient is trached and requires frequent suctioning, the charge RN will look at the charting (thank goodness for computerized charting!) and will check a box that will give a higher acuity score to this patient than he/she would to a person on 2L nasal cannula who's talking, eating, and able to expel their respiratory secretions into a tissue!

The trached patient is much more time consuming and a higher score will reflect that. So when the charge nurse makes assignments, this higher score will be taken into account and the RN will be assigned a relatively less time-consuming patient in addition to the trach. This is a VERY basic example. It's MUCH more complicated than this in the ICU (our max ratio 1:2).

Scores are documented every 24 hours by the charge nurse. Of course things can change throughout the course of 24 hours so it can be updated sooner as well.

I hope this is what you were looking for?

[dosamigos76, RN]

Begalli, thanks! That was really nice of you to take the time and interest to make such a timely and thorough response. I've noticed that you quite often put yourself out for others. It is appreciated!!

Cheryl

[Nai'aHI]

Here in Hawaii we use a similar system.

Every patient is assessed every shift, and a computer matrix-type questionnaire is answered with 'choices' such as -

1)Patient with no mobility limitations (independent)

2)Patient with some limited mobility (min assist)

3)Patient with moderate/max limited mobility (mod/max assist)

4)Patient totally dependent (total assist)

and so on.

This is done for ADLs, cognitive status, eating/not eating, complexity of care, frequency of required interventions (i.e. on the light every 5 minutes, or continuous monitoring).

The resulting score is from 1-4, with 1 the most independent, and 4 maximum complexity. The score gives an average which is then used to determine staffing for the unit for the upcoming shift.

Ex: If the mean score for the unit is 3.5 you get 6 licensed personnel and 2 aides; if mean score is 2.89 you get 5 licensed personnel and 3 aides, etc.

(These figures are just for example, and are NOT actually reflective of the true matrix.) The matrix is different for different floors/units - again to account for overall complexity/acuity - such as vented patients vs. non, telemetry vs. general med surg etc.

Also - we make sure that no one nurse gets all 1-2's or all 4's - makes the workload more balanced for everyone.

Hope this helps -

john

[Mystery5]

Acuities are a ridiculous waste of time, that's what they are. My hospital thankfully got rid of them and now staffs using common sense and nursing judgement.:)

[bamanurse]

I appreciate all of your wonderful explanations. It has greatly helped me and my group with our presentation. I can't thank you all enough.

[PamUK]

The Department of Health commissioned a report on patient acuity systems, used here in the UK in October 2002. There a five main methods

1. Professional judgement

2. Nurses per occupied bed

3. Acuity-quality method

4. Time/task activity approaches

4. Regrassion-based systems

At my hospital, we use a time/task activity approach called GRASP

But you can read the full report on

http://www.nuffield.leeds.ac.uk/downloads/nursing_teams_summary.pdf

The report gives a description of each of the systems, lists the strengths and weaknessess. You can find all the references to the report (all 88 pages of them) at:

http://www.nuffield.leeds.ac.uk/downloads/harvard_references.pdf

I think the report should get you kick-started on your assignment

Oh... and Good luck!

[PamUK]

Just read your last post... seems you have already completed your presentation

Never mind... might be helpful for others!