How to determine patient acuity

[Pudnluv, ASN, RN]

Does anyone know of any guidelines for determining patient acuity? I'm sure we can all pretty much do it in our heads, but I'm actually looking for documented recommendations. Without some kind of formal guideline, patient acuity can be left open to wide interpretation and manipulated to managemental desires.

[mama_d, BSN, RN]

We used to have a section of our flowsheet that we filled out, tallied up, and depending on the total the patient rated a 0-5 on acuity. Zero basically never happened. Five would indicate that they should be on step-down at least. It had categories like number of IV pushes/piggybacks, restraints, tube feeds, skin issues, etc. Honestly, they never staffed to acuity, so I don't know why they ever did it. They said initially that they were going to, but everyone knew they never would. It finally got phased off of the flow sheets after about two years.

[BookwormRN]

Our hospital uses the MESH system for acuity levels. Of course, nothing is perfect, but at least we have something other than ratios to go by. I've added the link below.

http://www.uwhealth.org/aboutuwhealth/managementandeducationservicesforhealthcaremesh/12761

[GrumpyRN63, ADN, RN]

We have one somewhere, and use to actually complete them on every shift, but as we were told my our manager it doesn't infuence our staffing ratio, so we don't bother

[mpccrn, BSN, RN]

i worked at a place that was trying to come up with an accuity scale. they had people actually follow us around and time every task required for a patient.......it was a complete joke and made no difference in how staffing was done....it was still staffing by number, not accuity.

[HonestRN]

Here are some basic guidelines for rating acuity. Patients are rated on a scale of 1-4 based on some of the following:

Level 1: VS X 1, A&O,independent care, 1-2 PO meds, saline lock, room air, 1-2 closed incisions OTA, no procedures

Level 2: VS X 1 and Orthostatic BP X 1, Fluid restrictions, 1 PRN med, 3-5 scheduled PO meds, 1-2 schedule SQ/IV meds, PCA, Labs X 1, O2 per NC or simple mask, O2 sats X 1, tele w/o changes, NG/G or J tube, chem strips X 1, simple drsg change

Level 3: Assess X 3, Neuro checks q 4 hrs. VS X 2, Orthostatic BP X 2, Oral care X 1, 3-4 3 emisis, TPN/Lipids, aspiration precautions, 2 PRN meds, 6-10 scheduled PO meds and/or crushed meds, 3 scheduled SQ and/or IV meds, 2 IV sites, Blood products tubes q 1-3 hrs, Post op bleeding, osotomy care, detox precautions, restraint alternatives, assist with elimination X 3-4, straight cath X 1, ck urine output q 4 hours, specimen collection X 2

Level 4: Assess >/= 4, Neuro cks >/= 4, VS > 2, Orthostatic BP X 3, ADL complete care, emesis >/= 5, oral care X 2, total feed, aspiration precautions, 2 PRN meds, > 10 PO meds, 4 scheduled SQ and or IV meds, 2 IV sites/lines, Meds crushed or per PEG/FT, multiple blood products >/= 2, detox protocol, lab intrerpetation >/= X 2, mech ventilation, cont or intermittant POX/O2 sats > X 2, Suctioning > 2, Trach care > 2, frq tele changes with interventions, chem strips > 2, dressing changes > 15 min or X3 or >/= 2 assist, osotmoy irrigation, freq alarm cks > 2 hrs, DT's, pt wanders, isolation precautions (contact, droplet, neutropenic etc), sitter, assist with elimination >/= 5, insert or poss foley insert, incontinent care X 2, bowel incontinence with freq loose stools, >/= 2 assist with BR, BSC or bedpan, IV insert X 2

These are basic guidelines and can be tweaked for any unit.

[Pudnluv, ASN, RN]

Thank you. Those are pretty good. Based on those guidelines, how would you staff your unit?

[HonestRN]

Thank you. Those are pretty good. Based on those guidelines, how would you staff your unit?

Would depend on how many pt's at what levels. Increased high levels, more staff. A nurse with a level 4 couldn't reasonably be expected to take on as many pt's as a nurse with levels 1 or 2.

[Pudnluv, ASN, RN]

Most of our patients rate a level 4 according to your scale. All our tele patients are q4 hour vs. We do have have some level 2 and 3 and rarely level 1. Currently are nurse to patient ratio is 6:1 on days with a target 4:1, eves 9:1 with a target of 6:1 and nights 10:1 with a target of 7:1. Many of the nurses have been there for at least 1 year, our newest for about 6 months. Most have at least 5 years on the floor.

[HonestRN]

Sounds to me that you have to beef up your staff and staffing levels.

Remember those are just guidelines and you can adjust the requirements as needed and desired for your particular unit

[Pudnluv, ASN, RN]

Thank you for the info. We are currently working on ways to improve our staffing, we just need some tangible info. Where do you get your guidelines from?

[uscstu4lfe]

we have a computer system that we log into. it asks a series of questions about each patient that we have, and based on our responses, it determines acuity. that information is then automatically sent to staffing, where appropriate staffing ratios are determined.