Use of patient acuity scale

An acuity system identifies the amount of nursing care needed for each patient on a unit, based on the level of intensity, nursing care and tasks needed for each patient. Acuity tool on the other hand promotes clinical expertise by enhancing nursing competence based on their medical complexity, ADL dependency, and behaviour challenges, determined by a formal assessment process.
Background: Less accuracy in predicting staffing needs as per patient’s condition
Under-estimating patient acuity levels can result in
•       insufficient staffing, leading to
•       increased workload,
•       decreased patient satisfaction
•       potential adverse events
Nursing Shortage & High patient turn over
•       Nurses are overburdened
•       the care requirements for multiple patients which decrease the ability
•       to recognize subtle changes or meet all the needs for care
A high Nurse-patient ratio leads to high adverse patient outcomes
Nursing sensitive indicators such as
•       falls, pressure ulcers, nosocomial infections, medication errors, patient satisfaction, and pain management
•       if proper allocation of patient not equally distributed
Methods: Descriptive qualitative study conducted in CCU among 20 nurses for three months.
Result: There was a reduction in dissatisfaction related to patient assigning from 84 to 10, Unable to complete the tasks involved from 70 to 10, nurses felt they needed help from 60 to 20, nurses felt they were incompetent from 42 to 0, Nurses felt they were unsupported from 90 to 0, Consultant complaints on inadequate staffing esp 1:1 in ICU from 4 to 1
Outcomes: Assigned nurses felt at ease taking care of patients based on their own level of competence. The training and OSCE stations greatly helped young nurses in performing critical procedures independently and competently. The handoff register between nurses allowed each to validate patient’s current acuity and care needs.
The tool allowed for competency based assignment versus the traditional experience – wise assignment.
Challenges: Although there was an initial resistance from consultants they soon realised that the tool was very useful inefficiently using nursing manpower.
Also Nurse Managers found it time consuming since they had to refer to the score sheet and match it with the nurses’ competency at every shift.