patient classification system,staffing

Patient classification system

Prepared by:1 -Ahmed Mohammed Zinhom

2 -Amira El Sayed

Under supervision:Prof: Nehad Fekry

Objectives: At the end of the lecture the student will

be able to: Define the pcs. Explain the purpose of pcs Discuss types of pcs Explain the difference between

prototype and factor type pcs. Explain formula for nursing work load

Standard.

1. Define:◦staffing◦staffing pattern◦staffing plan◦staff mixes

2-Enumerate the goal of staffing.

3-List objectives of staffing.

3-List types of staffing.

4-Identify methods for use of supplementary staff.

5-Identifiy factors affecting staffing pattern

determination.

6-Defferentiate between the two types of staffing

component.

7-Compare between tow types of patient

classification system.

8-Estimating staff requirement for the different

departments.

Out Lines: Introduction

Definition of pcs Purpose of pcs.

Importance of pcs. Types &styles of pcs.

Prototype evaluation system. Factor evaluation system.

Categories of pcs . Formula for nursing workload standard

-Definitions :◦ staffing ◦ staffing pattern◦ staffing plan◦ staff mixes

-The goal of staffing. -Objectives of staffing.

-Types of staffing pattern . -Factors affecting staffing pattern

determination.

Introduction: Care quality is highest when work load and staffing

resources are properly balanced. Serious understaffing impairs care quality, because

overworked nurses lack time to perform essential protective and therapeutic measures.

Marked overstaffing impairs care quality by encouraging excessive socializing among nursing personnel, which leads to relaxed practice standards and neglect of critical care measures.

Understaffing, overstaffing, and an improper staff mix diminish nurses, job satisfaction and cause excessive turnover, with significant financial.

Definition of staffing - Staffing refers to the number and mixture of personnel assigned to work in nursing units at a given time.

- Is defined as human resources planning to fill positions on

organization with qualified personnel.

- Is process of determining and providing the acceptable

number and mix of nursing personnel to met and produce

desired level of care to meet the patient's demand for care .

- Filling position in the organization structure through

identifying work force requirements , inventorying the

people available ,recruitment, selection, placement,

promotion, appraisal, compensation, and training of

needed people.

Staffing pattern:

Is a written plan that specifies the number and

classification type of staff personnel who are needed

to implement a care delivery model for each unit .

Staffing plan:

Indicates how many persons of what job

classification should be on duty per each unit

per shift .

Staff mixes:

Is the skill level of individual delivering the

required care ,In nursing it include : technical

nurses and practical nurses.

THE GOAL OF STAFFING:

- To provide adequate numbers of the

right mixture of nursing personnel to

give proper care to patients housed in

the unit at a particular time.

OBJECTIVES OF STAFFING:

- Establish a balance between the nursing staff available with

the manpower required ,according to the patients and their

care needs

- Provide sufficient staff to permit a1:1 nurse-patient ratio for

each shift in every critical care unit.

OBJECTIVES OF STAFFING CONT;

- Provide sufficient nursing staff general medical-

surgical ,obstetrics ,pediatrics, and psychiatric units to

permit a 1:5 nurse-patient ratio on day and afternoon

shifts and 1:10 nurse-patient ratio on night shifts.

- Summarize the data on actual versus required staff.

- Improve moral, job satisfaction and quality care with

decrease in turnover and vacancies.

OBJECTIVES OF STAFFING CONT;

- Evaluate staffing practices periodically.

- Recruit qualified personnel.

- Provide new employees with orientation period.

- Develop personnel policies that attract and provide

effective staff member.

STAFFING PROCESS

Staffing is logical operation that consist of several interdependent actions, such as:

1)Identifying the type and amount of services needed by organization client.

2 )Determining the personnel categories that have the knowledge and skill to perform needed

services measures. 3 )Predicting the number of personnel in each

job category that will be needed to meet anticipated services demands.

4)Obtaining budgeted points for the numbers in each job category needed to service for the expected types and number of clients.5) Recruiting personal to fill available positions.6) Selecting and appointing personnel from suitable applicant.

7 )Combing personnel into desired configuration by unit and shift.8) Orienting personnel to fulfill assigned responsibilities.9) Assigning responsibilities for client services to available personnel.

Staff classification

1-Professional nurse: Baccalaureate degree.

2-Technical nurse: Secondary Technical Nursing School . ( Diploma degree).

3-Auxiliary: messenger and transport personnel.

Components of Staffing1- Staffing pattern:

it is the number and mix of personnel that should be on duty per each unit per shift, per day.

2- Staffing plan:

It determines the number of nursing personnel that must be hired to deliver nursing care on the nursing units.

5-TYPES OF STAFFING PATTERN:There are three essential methods of nurse staffing pattern:

I. The traditional fixed staffing pattern.

II. The controlled variable staffing pattern.

III. The semi-flexible staffing pattern.

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I. The traditional fixed staffing pattern:

In this method the staffing pattern is built around a fixed

projected maximum workload requirement.

Limitation of this method: it ignores the fluctuation in the work

load(patients condition and number) or staff member

condition(shortage ,absenteeism)

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II. The controlled variable staffing pattern: In this method, the units are staffed below the maximum

workload conditions and staff is then supplemented as needed.

Although this is very effective method for staffing , it creates

dissatisfaction among staff.

Method for use of supplementary staff:1. Borrowing method

2. Floating method

3. On – call staff

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Methods used in supplementary staff :

A) Borrowing method This common method of borrowing staff from unit to

unit .to help those who have too little staff.

:The problem with this method is that

1 -the staff often resent being transferred from unit to unit

2 -the head nurse never admits that she has more nurses .

B) Floating method

This is a better method for managing staffing needs . Nurses who are permanent workers but don't belong to any special units are used to fill any shortage in staff

Advantage-:

1 -help to manage the day to day variations in work volume.

2 -some nurses like this method to gives her chance to work with different types of patient.

C) on-call staff

Usually on-call staff is filled with fixed staff that receive extra pay for being on call whether they are called or not .

This method is useful in OR , ICU

III. The semi-flexible staffing pattern :

In this method , about 10% to 15% of staff are fixed

and the rest flexible (supplementary) and the

volume is adjusted to match workload needs.

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6-FACTORS AFFECTING STAFFING PATTERN:

1. Nursing organization factors.

2. Patient factors.

3. Staff factors.

4. Health organization factors.

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Factors affecting staffing pattern Nursing organization factors

1.Patient care objectives 2.Determined level of patient care 3.Nursing division 4.Assignment system 5.Services to staff

Patient factors from the organization

Variety of patient conditions Acuity

Length of stay Patient number

Age groups ( pediatric , adults ) General health status and health goals

Staff factors 1 -Job description

2 -Educational level of staff 3 -Experience level of staff

4 -work ethics of staff members 5 -Expectation of staff

6 -staff number available

Health organization factors: 1 -financial resources available

2 -Personal polices 3 -Support services within the

organization 4 -Numbers of beds per units

5 -Budget available

Methods of determining the staffing pattern

1- The traditional system

1 - The number of beds per unit ( one

nurse per 4-6 beds), or

2 - The average census of patients per

unit ( one nurse per 4 patients).

The distribution of nurses is based on the nurse manager' opinion of the proportion of care that is needed on each shift and the adequate staff number to provide that care.

Example: Days: 45% of the staff Evenings 35% of the staff Nights 20% of the staff

The traditional system ignored that the group of patients might need more care than another group of the same number.

2- The advanced system

A- PATIENT CLASSIFICATION.

B- TASK QUANTIFICATION.

Focuses on patient needs. Patients are grouped according to the acuity of their needs and the degree of their dependency on nurses. The patients grouped according to their nursing needs into 3 or more groups:

Group 1: Self careGroup 2: Partial or intermediate careGroup 3: Intensive or total care

For example:-Determining nursing care hour by patient classification system in medical-surgical unit by

No of pts Acuity level of care Associated hours of care Total No of hr needed

3 I 2 6

10 II 6 60

11 III 7 77

2 IV 9 18

36 161

Task quantification system

Focuses on nursing tasks. To be performed. Common nursing tasks are either direct nursing care ( in the presence of the patient as in giving medication, measuring vital signs…..) or indirect nursing care ( away from the patients as in preparing medication , documentation in patients' files, giving instructions or educative sessions……)

7-STAFFING COMPONENT:I. Staffing plan:

Indicates scheme mathematically derived to indicate how many

people of what classification must be hired in order to deliver

staffing pattern.

Staffing pattern determine positions which required to the unit

or the hospital, but staffing plan determine the number of

workers to fill those position.

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• Methods of staffing plan:1- Using calendar days:

Divided the number of days in the year by the number of days actually

worked per nurse per year to drive the number of staff required to fill

one position for the year. Example :

In some Hospitals in the ICU:1. The nurse worked 17 days per month

2. So actual working days/year=17×12=204 days

3. The number of nurses needed to fill one position of professional nurse = 364/204=1.8 worker.

4. The number of nurses to fill 6 positions of LPN/year = 6*1.8=11 nurses.

2-using the care hours-: Calculate P.T hours/unit/shift.

Calculate the total number of nursing hours

required/year.

Calculate the number of staff required to deliver those

hours.

Calculate the number of positions required to deliver

that staff.

Example : In the chemotherapy unitThe patient needs 2 hours of care.The patient come to take this therapy daily=20.So the number of patient care hours = 2×20=40h/day.The number of hours in one shift= 8h.Then the nurse required to give these hours= 40/8= 5 P.NThe number of workers to fill one position of nurse=1.65So the number of nurses required to fill 5 positions of P.N = 5*1.65=8nurses

• Factors influencing staffing plan:Job description.

Personnel policies.

Variability in patient care requirement.

Budged resources.

Equipment, supplies and technology.

Staff category.

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Criteria for Effective Staffing Procedure

An effective allocation procedure meets the following criteria:

Coverage: the number of nurses assigned to be on duty should be in relation to the minimum number of nurses required

Quality: the total number of patient care should be planned in such a way that trained nurses are available for patient care of 24 hours a day. It should also cover off days on rotation.

Criteria for Effective Staffing Procedure

Stability: allocation procedure must be consistent with leave and rotation policy. Each nurse must know her off, privileged leave etc.

Flexibility: the allocation policy must provide for flexibility e.g., if a request for days off or leave comes as emergency, that should be taken care of.

Objectives: there should be fairness in allocation and scheduling shift duties

Written staffing policies should be readily available in at least the following areas :-

1 -Vacations 2 -Holidays 3 -Sick leave

4 -Weekend off 5 -Over time 6 -Part – time

7-Absenteeism 8-Emergency day off

II. Staffing pattern:Staffing pattern prediction:

To predict the personnel allocation and scheduling system the manager

has to the amount and type of nursing care needed in each nursing

unit(nursing workload).

Work load component:.1Indirect care : which is consist in each unit

.2Direct care: activities which is varies according to the number and

type of patient (patient classification).

Patient classification system

Definition : A patient classification system is a method for grouping

patients According to the amount and complexity of their nursing care requirements.

Is a system developed to objectively determine workload requirement, Staffing needs and work hours.

It serves as a tool to measure patient needs, care giver interventions and skills level required to meet this needs

In most classification systems, patient are grouped according to their dependency on care givers or the amount of caretaker time and ability employed in caring for them.

Purposes of pcs: 1. Determine the required nursing hours needed to provide safe

and efficient patient care based on standards of care and practice

2. Determine the number and category of staff (skill mix) needed for providing quality of patient care.

3. Provide data on each patient care unite that directs and support staffing in decision making

4. Assess level and support services required. 5. Enhance staff satisfaction through stress free work environment 6. Categorize patients according their needs and the time and skill needed to satisfy each category needs. 7. Determine work load and nursing care requirements. 8. Recognize time for nursing care needed.

Importance of pcs: 1. Improve patient satisfaction by providing required time to the

patient according to his\her needs . 2. Enhance staff satisfaction by determining staffing needs and

those decreasing workload. 3. Monitor provision of quality nursing care According to

international standard in safe work environment.

Characteristics: 1. Differentiate between intensity of care among definite classes 2. Match nursing resources to patient care requirement relate to

time and effort spend on associated activity 3. Economical and convenient to use . 4. Global 5. Objective

6. Flexible 7. Easy to understand

Patients are classified according to the following criteria:

1-The activity of living

2-feeding

3-Grooming

4-Toileting

5-Comfort measures

6-Mobility

Types or Styles of pcs: Pcs is also known as patient acuity systems and are used to assist nurse leader to determine workload, requirements and staffing needs(sullivan,2005) There are different kind of pcs available, but according to Sullivan ,the three most commonly used pcs as following:

1. Descriptive :- The nurse chooses the category that best describes the patient 2. The check list style : The nurse checks the activity level for each patient in each category and totals the points for each patient to determine the level of care 3. Time standard method: Another method which charge nurse assigns time value based on various activities that need to be completed for the patient

Other types of pcs: i. Prototype evaluation system. Factor evaluation system

Prototype evaluation system: Describes typical patient and varying need levels. Characteristics are listed in five care category as follows:

1. Category I: patient with acute non chronic, episodic disease or disability who will return to the pre illness level of functioning & the care goal complete elimination of the existing health problem

2. Category II : patient with chronic disease on which is superimposed on acute episode of illness, who have the potential to return to the pre episodic level of functioning and the care goal managing chronic health problem by patient and family without ongoing support from agency.

1. Category III : patient with chronic disease or disability where return pre illness level functioning in not possible but there is potential to increase the level of functioning, rehabilitation to maximize level of functioning through continuing agency support .

2. Category IV : patient with chronic disease or disability who cant be maintained at home without ongoing agency support ,for whom the care goal is maintenance at home at maximum level of functioning through ongoing agency support.

3. Category V : Patient with en stage illness for whom the care goal is assurance of comfort and dignity throughout two terminal stage of illness

Factors evaluation system: in the factor evaluation system number of critical care descriptors are identified and patient care needs are scored according patient dependency level

Categories of patient classification systems : Category 1 : Self-care requiring from 1 to 2 hours per day

. Category 2 : Minimal care requiring from 3 to 4 hours . Category 3 : Intermediate care requiring from 5 to 6

hours Category 4 : Modified intensive care requiring from 7 to

8 hours . Category 5: Intensive care requiring from 10 to 14 hours

Criteria for Evaluating the Usefulness of Patient Classification Systems:

1 -HOW WELL DOES THE PATIENT CLASSIFICATION SYSTEM ACCOUNT FOR VARIATIONS IN PATIENT NEEDS FOR

HOSPITAL SERVICES?IDENTIFYING PATIENT NEEDS. EASY AND QUACK ADAPTATION WITH CHANGED PATIENT NEEDS. RESOURCES . FLEXIBLE.


2 -How strong Is the Patient Classification System ?

refers to the ability of the system to maintain its properties despite changes in the data used to create or operate the system , persons using system.


3 -How Reliable Are Patient Assignments to Category?

Reliability should be assessed at several levels : primary data which as (sex, age, vital signs and lab test results , diagnosis,…) category assignment (require subjectiveJudgment)


4 -How Does the Patient Classification System Affect Economic Incentives?

admission status (emergency vs. non emergency), Because emergency admissions have significantly higher costs and lengths of stay.


5 -To What Extent Is the Patient Classification System Meaningful to Care providers?

care providers must understand the system knowing PCS importance resources.


6 -How Feasible and valuable Is the System To Use?

classification systems that use more detailed data, revision, easy to use, understand.

should be capable by computer to minimize cost , save time and enhance feasibility

Measurement of pcs:

NCH /PPD = NURSING HOURS WORKED IN 24 HOURS

PATIENT CENSUS

Using the care hours for developing staffing patternHospitals used the patient care hours for developing staffing pattern, can

calculate the staffing plan using the care hours methods.

For example:----------------------------------------------------------X

Estimating a core staff per shift

Bed number in surgical unit= 25 bed

The average daily census for 6 month = 19 patients

The average daily care hour to be provided= 5 hour per pt/24 hour.

Total hours of care will be needed= 19x5= 95 hours.

If the work day is 8 hours , then 95 divided on 8

= 11.9 or 12 FTE staff needed to unit for 24 hour.

Total of 12 EFT x 7 days / week = 84 shift / work--------------------------------xIf the employee work 5 hours shift / week, then 84

5 = 16.8 the number of EFT needed.

The needed on each shift and the adequate staff number to provide that care.Example: days: 45% of staff

45x16.8/100=7.56=8Evenings 35% of the staff

35x16.8/100=5.88=6Nights 20% of the staff

20x16.8/100=3.34=3

Total Night

Evening

Day Category

9

5

3

2

1

-

3

2

1

4

2

2

RNs

LPN

Other17 3 6 8 Total

QUESTION????

Health & Medicine

patient classification system,staffing