CNA/ACP Acuity Tool

(Tally all Yes in each column to obtain pt acuity)

Score of 4 or greater Yes = acuity of 6

Rm ________
Yes No
Patient Confused/Agitated
Toileting: Voiding frequency/urgency
(Calls for assistance >3 times a shift for toileting) when HIGH
FALL RISK PATIENT (Must stay in the room when toileting or
ambulating)

Full assistance required for ADLs (bathing, toileting, mobility,
and/or feeding)

Pt incontinent (bed change >2 times a shift)
Impulsive
Patient requires full assistance for 3 walks and up to the chair
for meals each shift

Contact Precautions (only mark Yes if the pt is incontinent or
urine or stool. If the pt is independent, please check no.)

Tally Yes Column =

Score of 4 or greater total Yes = pt acuity of 6. One less patient should be assigned to
CNA/ACP to accommodate heavy patient load. Please notify your charge nurse.


Rm ________
Yes No
Patient Confused/Agitated
Toileting: Voiding frequency/urgency
(Calls for assistance >3 times a shift for toileting) when HIGH
FALL RISK PATIENT (Must stay in the room when toileting or
ambulating)

Full assistance required for ADLs (bathing, toileting, mobility,
and/or feeding)

Pt incontinent (bed change >2 times a shift)
Impulsive
Patient requires full assistance for 3 walks and up to the chair
for meals each shift

Contact Precautions (only mark Yes if the pt is incontinent or
urine or stool. If the pt is independent, please check no.)

Tally Yes Column =

Score of 4 or greater total Yes = pt acuity of 6. One less patient should be assigned to
CNA/ACP to accommodate heavy patient load. Please notify your charge nurse.