How to determine patient acuity

[Pudnluv]

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.

[HouTx, BSN, MSN, EdD]

This is really a very interesting subject, and it all hinges on how you define nursing. Actually, I used to develop these types of systems as a consultant & it paid very well.

Most 'acuity systems' are simply laundry lists of tasks -- like the one outlined by a previous poster. These tasks certainly add to the workload, but they don't completely reflect the work of nursing.

Workload and Intensity are actually 2 separate issues when it comes to staffing. You can have a 'high task' patient (comatose) but most of the the work could be handled by a nurse assistant. On the other hand, you could have a new diabetic - completely ambulatory and self care, but with extremely high teaching and emotional support needs - high intensity - that requires a LOT of RN time.

Of course, acuity systems also fail to account for the ADT 'noise' (admissions, discharges & transfers) that are very time consuming. We all know you can start & end the shift with 4 patients, but the ones you ended up with are not the ones you started with!

All in all, I don't think that there is any task list that can replace good old nursing judgement. I am a proponent of 'prototype' acuity systems that consider both workload and acuity. But they need to be coupled with additonal workload attached to the ADT.

It's no wonder that so many hospitals have just given up and rely on ratios.

[BookwormRN]

Of course, acuity systems also fail to account for the ADT 'noise' (admissions, discharges & transfers) that are very time consuming. We all know you can start & end the shift with 4 patients, but the ones you ended up with are not the ones you started with!

Actually, our acuity system (MESH) does take into account admissions, discharges and transfers on the unit. We do get "points" for these things. Sometimes, I agree the points are a true indication of the time spent, but at least it does boost the acuity!

[Pudnluv, ASN, RN]

Safe staffing has to start somewhere. It has to be more than just the numbers. I think a laundry list of tasks for determining acuity is a good place to start. It gets away from the number nurse to patient ratio system. And it can be tweaked and upgraded depending on the needs of the unit. I truly appreciate everyones feedback on the issue. Some of us from my unit are really trying to change the system.

[momofdandm]

We have a 1-2-3 acuity sheet that each shift fills out. The charge nurse then uses it to determine the assignment for the oncoming shift.

A 1 is for an easy pt. A&Ox3, ambulatory, not a lot of meds, hardly on the call light.

A 3 is for q2h turns, drsg changes, lots of meds, on the call light constantly, incontinent.

A 2 is anywhere in the middle

There are numerous times where we put that a pt is 1-2. That is, they are an easy pt, but they have a little more going on that would make them closer to a 2 as well, but not quite a 2.

Our acuity boards have things like drsg changes, discharges, accuchecks, we also write in if they are q2turns, have foleys, lot of prn pain meds, etc. It's a great system and all charge nurses use it wisely, for the most part, when making assignments.