I've been casually working to create a tool for objectively measuring and classifying the current and anticipated acuity levels of the patients on my unit. I know that peoples' definitions of what constitutes a high acuity patient may differ vastly based upon numerous factors, and I don't want to create something that reflects only what I consider acuity to entail. I'm interested in hearing what other nurses believe influences a patients acuity, whether it is objective or subjective, or pertaining to the level of skill required, physical demand, knowledge, time consumption, a particular diagnosis, patient condition....whatever springs to mind when YOU think of acuity! It doesn't matter if you have evidence or an explanation to support your ideas, any input would be greatly appreciated.
Just for some background, I work on an inpatient hem/onc unit that includes med surg overflow as well as an increasing number of renal patients. I am well aware that programs exist to aid in this very thing, however, my hospital still uses paper charting, is by no means advanced in the way of electronic information utilization, and I am hoping to develop something to use as a guideline rather than a strictly interpreted system.
I work in ICU and to me it means "will die without constant intervention". I know there are numerous scales and ways of measuring acuity, but that is mine.
Specializes in Oncology/Hematology, Infusion, clinical.
Sounds like incorporating interventions would be a great help in my project. Thanks to that response.
I know that no acuity scale I could ever make is going to actually get more staffing. Its more of an attempt to organize things on my unit and to help create assignments that are appropriate for the nurses we are given, help everyone have a general idea as to what's going on with all the patients on the floor, and to assist in determining which room is most appropriate for a given patient. Basically, I'd like to make it suck less using whatever their crappy staffing grid give us.
I can say, at least, we've griped enough to now treat certain patients (acute leukemics) as 2 instead of 1 for our unit census. I guess we'll see where that goes...
We use an acuity guide in our PICU but it mainly helps to justify a 1:1 patient (or even 2:1 (?) with 2 nurses for one patient). Top to bottom categories (neuro, resp, CV, etc). I don't have it in front of me but it is based off of interventions, drips, lab draws (how many in a shift), lines, tubes and procedures in a shift. For example if you are putting in new lines or taking a road trip (CT, MRI) that bumps it up. That patient obviously takes more time and requires more attention. Our ratio is 2 patients per RN and they could both be vented and busy but a "stable" critical, if that makes sense. A 1:1 would be that train wreck patient that is admitted, gets intubated, central line placed, sedation drips started, cardiac drips started, foley, OD, CT, cultures, Q2 labs, med orders, multiple xrays, blood products, electrolyte replacement, etc. Usually any patient on an oscillator is a 1:1 but they can sometimes be stable 1:1's and in that case can be paired. Usually several cardiac drips will get a bump to a 1:1. Any kid on CRRT is a 2:1 due to one nurse needed to run the CRRT machine. I did have one patient that had three nurses to her. She was on every cardiac drip there was, multiple blood products, multiple meds, lab draws. One nurse took assessments and interventions and I took lines, lab draws (Q2 labs draws, Q1 accuchecks), and IV meds/blood products (so imagine managing multiple lines and drips and confirming compatibilities and timing blood products). We both ran our butts off and we added a third nurse because she ended up going on CRRT that same shift.
Not to hijack, but maybe along the same lines...do any of you have tools at your facilities to gauge staff based off of skills and experience to help with assignments? A way to ensure consistency in assignments and rewarded skills and experience (allowing staff to grow, not having same people get assignments)? I know of one facility that uses a ranking system. You had to test to get to the next rank which allows you to take higher acuity patients. The only problem is that a lot of the highest rank nurses were getting really burned out and ended up leaving for other places and the other ranked nurses didn't want to test up to the highest level (only getting the train wreck kids that they see for months on end, always running super busy).
Specializes in Oncology/Hematology, Infusion, clinical.
Thanks for all the info in your response. Re: your question. The testing method you mentions sounds like if it were tweaked it could be successful. Do you have a high rn turnover, or a lot of new grads? For example, if you developed a system in orientation with a timeline for being tested at certain intervals and expectations for achievement of a certain level in x time frame. And for established employees the same, so that in x amount of time, they are expected to be at x level. IncentiVes may help, and you could hope to reach a point where many/most of the staff are at the upper level, meaning they won't have onle a couple of nurses who take only intense pts. all time, and rather, everyone (or most) would be able to take the highest acuity and have a more leveled assignment. I don't know, but it sounds good in theory. Then again, so does communism.
nurse2033, MSN, RN
3 Articles; 2,133 Posts
I work in ICU and to me it means "will die without constant intervention". I know there are numerous scales and ways of measuring acuity, but that is mine.