Dependency and acuity audit

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Dependency and acuity audit

• Sue Chapman

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The problem

• No clear definition of what is meant by high
  dependency and one to one care
• No clear way to identify children who require
  normal dependency, high dependency and 11
  care
• Limited information on paediatric nursing
  staffing levels.
• No tool to assess paediatric nursing staffing
  levels based on actual patient acuity rather than
  identified bed dependency

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Outside GOSH

• Limited work in adults or paediatrics
• Early work in Woodland ward
• 2 key documents
• High Dependency care for Children (DoH 2001)
• Defining staffing levels for children and young
  peoples services (RCN 2003)

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Developing the tool

• Patient acuity
• 42 care categories derived from DoH
  recommendations
• 3 additional categories
• Expert nursing opinion and DoH guidance

• Nursing Dependency
• 4 categories

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• Patient acuity
• 42 care categories derived from DoH
  recommendations
• 3 additional categories
• Expert nursing opinion and DoH guidance

• Nursing Dependency
• 4 categories

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Developing the tool

• Try to keep it simple
• User friendly - 1 sheet per shift
• Assess each child every 12 hours
• Assess each child again 45 categories

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The finished product!
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The Audit

• All in-patient wards (except intensive care and
  some daycase areas)
• 4 weeks (April May 2005)
• Assess each patient every 12 hours
• Entered in Excel Spreadsheet database

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The results

• 28 wards/units
• Overall return rate 91 (59-100)
• 42 of children require HD or WIC
• Generally good correlation with nursing staffing
  requirement
• Ability to identify acuity across individual
  wards, divisions, the whole Trust
• Ability to identify need across days of the week
• Individual report for Senior Nurse to disseminate

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The Future

• Few modifications needed from pilot (50
  categories)
• v2 at the printers!!
• Repeat for 3 months starting October 3rd
• Review
• GOSHman online?
• Publish !!

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The Good

• Planning does help
• Enlist supporters
• Support from Clinical Audit Department
  invaluable!
• Staff enthusiasm
• Benefits to the Trust
• External interest

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The Bad

• Trying to KISS
• Keeping staff informed
• The size of the project
• Disseminating the results
• Massive amounts of data
• Mushroom effect!

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And The Ugly (Not really Mark)