ONS 2021 Guideline Question Identification
Video Tutorial: https://www.loom.com/share/44cd7351da0346fd93ec43b7306e04e3
Each week, Pam will post questions as ideas. Please comment in each idea to answer the questions that have been posed. We encourage you to reference other panelists' responses to make this more of a conversation. We will notify you when next week's questions are posted.
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When taking on the role of director in my practice in 2012, i was presented with an acuity tool from CJON as a basis for our staffing metrics. While the tool is meant to be a daily staffing guide as the patient treatment lengths are weighted, we use it more as an overall staffing tool for optimal FTE staff in each location. It utilizes a weight system based on length of the infusion appointment. This can be a little misleading because it assumes that the longer an infusion is, the more complex the patient is. This is not always the case. We had to then find additional staffing matrix ideas for support staff such as LVN's, Triage and Pharm Tech, which again, are not useful for day to day needs but to support an overall target for FTE.
My first dive into acuity tools started in 2008 in an effort to improve patient/staff satisfaction and ensure better utilization of the treatment schedule and our nursing team. I searched the literature and tailored the acuity scale I found to meet the needs of our unit; it was a 1-5 scale. We categorized our treatment types into these 5 levels of care and created "weighted" visits based off of a 9.5 hour day. Each level had nursing time assigned to it and we would retrospectively look at completed appointments. We'd "code" the completed appointments with the acuity levels to see a daily pattern of level 1-5 appointment types. Based off of the acuity scale/weighted visit times we'd compare recommended FTE's to actual FTEs. We also reviewed data to determine how well the workload was distributed among the team and what the average acuity load per RN was for the assignments.
Work around acuity evolved over time and we ultimately used 3 different methods to create an ideal RN:Patient ratio staffing model which has been utilized from 2013 to current state. For our purposes we have found acuity to be an adjunct to our staffing model but it does not paint the entire picture for a staffing model.