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7/29/2019
Nursing Informatics
When my research began the most difficult aspect of this assignment was
identifying the policy and work- flow that could be changed to benefit the patients
and employees on my unit. After weeks of pondering, the answer had been right in
front of me the entire time, especially on our busy nights with no Aid or
Technician to help. The current CDU policy is that our CNA can be pulled to
other units when needed, if we do not have at least 8 patients in our census. CDU
is a fairly-new unit nationwide and the patients are typically ambulatory and self-
reliant, so they don’t always require a lot of 1 to 1 care. The down-side to this is
that we do not always get the proper staffing needed to adequately provide care to
the patients and make our jobs a bit more manageable. On nights without an Aid
the nurses must go to the Emergency Department to get the patient, perform vitals,
labs, establish telemetry, and document a thorough assessment of the patient when
we arrive on the unit. Having an Aid every night would be vital for patient care,
patient satisfaction, and more lucrative financially. Because we are a special unit,
we receive more compensation within that first hour of observation to the unit
versus any subsequent hour. Having a CNA daily would pay for itself every shift
policies that use informatics such as, acuity tools and MEWS to supply efficient
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POLICY REFORMATION
Since the 1980’s Patient Classification Systems, or PCS’s have been in use
to predict patient requirements for nursing care and used to manage nursing
personnel, resources, costs, and quality. ("Patient Acuity - Patient Safety and Quality - NCBI
Bookshelf," n.d.) To date, not many healthcare facilities utilize these PCS
instruments because not much research has been conducted on their effectiveness.
More research has been focused on the development and comparing of the
instruments themselves instead of studying the extent that these programs are being
used. ("Patient Acuity - Patient Safety and Quality - NCBI Bookshelf," n.d.) Many studies have
provided research that says acuity is on the rise but only 4 actually studied trends
Ironically, all of these studies were conducted in other countries such as Australia.
PCS scores were compared over the same 3 month periods in 1996 and 1999. It
was found that acuity varied by shift and that evening was by far the most acute.
PCS scores of 1999 were found to be considerably higher than those scores of
1996, in a particular Australian hospital. ("Patient Acuity - Patient Safety and Quality -
NCBI Bookshelf," n.d.) Subsequent PCS studies from a Swedish hospital from 1995-
1996 concluded that patients were sicker, treatments were more time consuming,
and less cost effective than in the previous year. ("Patient Acuity - Patient Safety and
Quality - NCBI Bookshelf," n.d.) In each empirical study it is proven that acuity is on the
rise and that Patient Classification Systems are beneficial in every aspect of patient
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POLICY REFORMATION
care but is only utilized in a small percentage of the healthcare population. A few
barriers to adopting PCS’s are that they are often complex and require considerable
time to complete. The only barrier I see that would concern my unit is that the
systems are not designed to detect census variability throughout the day such as
admissions and discharges. ("Patient Acuity - Patient Safety and Quality - NCBI Bookshelf,"
n.d.) Regardless of the minor imperfections these systems encounter, they have
shown to be beneficial in patient safety and care, as well as ease the work load on
our nurses.
help nurses serve patients with minimal risk of error as long as proper protocol is
always followed. When nurses are short staffed and patient acuity is high, there is
always more chance of mistakes to be made. Personnel may take short cuts to med
administration such as not scanning the patient and medication, and not visually
Threats to Patient Safety," 2008) Another common work-around that nurses perform is
pre-scanning medications for multiple patients and carrying them around on their
Administration Systems: Their Occurrences, Causes, and Threats to Patient Safety," 2008) These
negligent practices can result in medication errors and impede patient safety and
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treatment as well as lead to losing the practice license that we all have worked so
hard for. This is a prime example of the chain of events that can unfold when
nurses are short staffed. Another efficient system that can help nurses identify a
Systems. The MEWS is designed to track patients’ vital signs and alert nurses of
any acute changes in condition. On nights when we are short staffed and have 7
patients each, this is a critical tool to have in your arsenal as a nurse. Sometimes it
is easy to miss small but important details such as a patient’s temperature starting
to creep up, or their oxygen saturation declining, or heart rate increasing. Some of
these could be signs and symptoms of sepsis, which we would need to treat very
In all the research done on patient acuity and safety, there is a positive
correlation between number of staff members and safe patient outcomes. The
more nurses and CNA’s available, the more we can minimize falls and medication
errors. Sufficient staffing also leads to better patient satisfaction. Research shows
that total hours of care from all nursing personnel is directly associated with rates
of decubiti, complaints, and mortality. It was also found that as the RN proportion
increases the rates of adverse outcomes decreased up to 87.5%. ("Nurse Staffing and
Patient Outcomes : Nursing Research," n.d.) The CDU is a small unit which consists of 7
rooms with 14 beds. Some nights we are allowed to have 3 nurses and an aid if
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POLICY REFORMATION
census and budget both allow it. On these nights 4 to 5 patients is much more
manageable, and I’m able to provide higher quality of care to each individual
patient. It is a much safer environment for the patients and much less stressful for
the personnel. The extra money required for staffing is recoverable and justified
due to less injuries, decreased infections, minimal medication errors, and increased
patient satisfaction. It is far more cost effective to pay for adequate staffing than to
pay a million-dollar law-suit. ("Nurse Staffing and Patient Outcomes : Nursing Research,"
n.d.) The bottom line in healthcare is and has always been patient centered care
and patient safety. When we lack adequate staffing then we are essentially
compromising patient care and putting them at higher risk for falls and medication
errors. ("Nurse Staffing and Patient Outcomes : Nursing Research," n.d.) The patients are at
our mercy when they are admitted to our hospitals and often depend on us for food,
drinks, and hygiene in addition to providing their medical care. It is our duty to
make their stay with us comfortable and provide them the best care possible.
Through the use of informatics and proper staffing, we can truly create an
When I began this project, I struggled to find a topic that I could identify
this staffing issue, I feel that I could take my findings to the next shared
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governance meeting and present the proposal of more staffing and a proper PCS
REFERENCES
Nurse Staffing and Patient Outcomes : Nursing Research. (n.d.). Retrieved from
https://journals.lww.com/nursingresearchonline/Abstract/1998/01000/Nurse_Staffi
ng_and_Patient_Outcomes.8.aspx
Patient Acuity - Patient Safety and Quality - NCBI Bookshelf. (n.d.). Retrieved
from https://www.ncbi.nlm.nih.gov/books/NBK2680/