Transcript Acuity Plus - Shellie Raisanen

Acuity Plus
TM
Accurate Rating and Documentation
OBJECTIVES
 Learners will articulate and demonstrate
appropriate classification for patients in
Acuity Plus and provide documentation in
CERNER-Power Chart to support the
classification.
TM
Significance
 ALL patients (including new admissions,
discharged patients, transfers) must be
classified to accurately reflect patient needsdefault classification are given that may not be
accurate.
 This is a PROACTIVE system.
 Documentation in Patient Care Summary must
support classifications!!
 Unit managers are held responsible for
reliability- meaning documentation must match
classification.
Classification Indicators
Classify each patient 0700-1100 dailyyou are able to adjust times if late.
CCU’s will classify BID.
Classification is based on patient care
needs and not RN tasks.
Ability to edit changes to patient status
anytime using edit function.
Use the mouse to hover over an indicator
and you will see a complete definition.
ADL Indicators
Select only one indicator (1-2-3):
3 determinants for ADL’sNutrition, Bathing, Mobility
1 ADL-Self/Minimal Care:
independently performs ADL’s or
minimal assistance
2 ADL-Partial Care: requires
assistance/ supervision in any one or
more ADL’s
3 ADL-Complete Care: dependent on
staff for all three ADL’s
4 ADL-Rehabilitative: patient requires
assessment/intervention to
restore/achieve highest ADL
attainable. Staff working with patient
in cognitive manner to achieve higher
level of independence
• An ACTIVE Rehab Plan of Care must
be charted by PT/OT/SLP for a
patient to qualify. A consult does NOT
qualify patient
1 ADL-Self/minimal Care
Application
Documentation
Location
Nutrition: Assistance
Gastrointestinal
opening containers,
cutting/preparing food
Bathing: Assistance in
Skin
preparing for shower/bath
Mobility: Independent
Musculoskeletal
Documentation
Specifics
Meal Assistance:
Independent
Hygiene Assistance: setup or independent
Level of Assistance:
independent
1 ADL-Self/Minimal Care: independently
performs ADL’s or minimal assistance
2 ADL-Partial Care
Application
Documentation
Location
Documentation
Specifics
Nutrition: needs cueing,
is a feed, has a feeding
tube
Bathing: needs cueing,
assistance in bathing
Mobility: needs cueing,
needs assistance to
move in/out of bed,
assistance ambulating,
assistance moving in bed
Gastrointestinal
Meal Assistance:
Assisted
Tube Feeding
Hygiene Assistance:
Assist
Level of Assistance:
Minimal, moderate or
Maximum assistance or
Standby assistance or
Supervision
Score 6 or greater
Skin
Musculoskeletal
Fall Risk Assessment
2 ADL-Partial Care: requires assistance/
supervision in any one or more ADL’s
3 ADL-Complete Care
Application
Documentation
Location
Documentation
Specifics
Nutrition: total feed, tube
feed or NPO
Bathing: no participation
from patient
Mobility: dependent on
staff to move
Gastrointestinal
Dependent
NPO
Complete
Skin
Musculoskeletal
Dependent
Maximum assist
3 ADL-Complete Care: dependent on staff
for all three ADL’s
4 ADL-Rehabilitative
Application
Documentation
Location
Documentation
Specifics
An ACTIVE Rehab Plan
of Care must be charted
by PT/OT/SLP for a
patient to qualify.
A consult does NOT
qualify patient
Results: Documents
PT/OT/SLP for the
assessment and plan
4 ADL-Rehabilitative: patient requires
assessment/intervention to restore/achieve highest
ADL attainable. Staff working with patient in
cognitive manner to achieve higher level of
independence
• An ACTIVE Rehab Plan of Care must be charted by
PT/OT/SLP for a patient to qualify. A consult does
NOT qualify patient
ADL Assistance Indicators
Select only one indicator 5-6
(if applicable)
5 ADL Assistance- 2-3 caregivers:
Select for patient who requires two
or three caregivers to complete any
activity of daily living.
6 ADL Assistance- 4 or more
caregivers: Select for a patient that
requires four or more caregivers to
complete any activity of daily living.
5 ADL Assistance 2-3 caregivers
Application
Documentation
Location
Documentation
Specifics
2 to 3 staff required for
any ADL: nutrition,
bathing, mobility
Musculoskeletal
Skin
Gastrointestinal
Dependent
Number of staff needed
for mobility
5 ADL Assistance- 2-3 caregivers: Select
for patient who requires two or three
caregivers to complete any activity of
daily living.
6 ADL Assistance 4 or more
caregivers
Application
Documentation
Location
A patient who requires 4 Musculoskeletal
or more staff for any ADL:
nutrition, bathing, mobility Skin
Gastrointestinal
Documentation
Specifics
Dependent
Number of staff needed
for mobility (new to
charting-4 or more
caregivers)
6 ADL Assistance 4 or more caregivers:
Select for a patient that requires four or
more caregivers to complete any
activity of daily living.
Communication/Cognitive
support Indicators
7 Communication Support: Select
for a patient who requires
additional care due to
uncompensated vision, hearing,
speech deficits, language barriers
or limitations related to literacy.
 Also applies if the additional care is
provided to the patient’s
family/significant other.
 Do not use this for unconscious or
sedated patients
8 Cognitive Support: Select for
a patient who, due to
temporary or permanent
limitations or alterations in
cognitive functioning, requires
an assessment and
intervention to orient to
person, place or time.
• Do not use this for
unconscious patients
• Do not use this for infants
7 Communication Indicator
Application
Documentation
Location
Documentation
Specifics
English not the primary language Profile
Language Spoken
Hard of hearing and without a
hearing aid or with an effective
hearing aid Deaf,
Blind
Presence of an endotracheal
tube or tracheostomy and is
unable to speak but is attempting
to communicate
Mute, expressive or receptive
aphasia
Extensive oral or EENT
procedure compromising the
ability to communicate
Illiterate requiring assistance
completing/reading necessary
forms or educational materials.
Cognitive Perceptual
HOH without hearing aid
HOH even with hearing aid
Deaf
Blind
ETT or Trach
Speech
Level of conscious and
Communicating by
Speech
Cognitive Perceptual
Speech
Patient Education
Learner Assessment
Neuro detailed: Sensory
Assessment
Profile
Artificial Airway
Cognitive Perceptual
Wakeup assessment
8 Cognitive Indicator
Application
Documentation
Location
Dementia, confusion,
Cognitive Perceptual
disorientation, autistic,
developmentally
Neuro Detailed
challenged or confusion
due to general
anesthesia or sedation
requiring assessment
and reorientation or other
interventions.
Documentation
Specifics
Level of consciousness
Neuro interventions
Behavior/Emotional Indicators
Select only one indicator 9-10
(if applicable)
9 Behavior/Emotional
Management: Select for a
patient who requires intervention
to manage behavior or emotions
to maintain/regain the ability to
participate in the plan of care.
• Also applies if the intervention is
provided to the patient’s family /
significant other.
10 Behavior/Emotional
Management-1 hour: Select
for a patient who requires
intervention to manage
behavior or emotions to
maintain/regain the ability to
participate in the plan of care
every one hour or more often
for the majority of the
classification period.
• Also applies if the intervention
is provided to the patient’s
family / significant other.
9 Behavior/Emotional
Management
Application
Documentation
Location
Visibly upset and / or anxious
Psych Social
requires comforting and/or limitsetting.
Behavior that requires placement Restraint Assessment
in soft or leather restraints to
manage behavior, including
attempts to remove
catheters/tubes.
Disruptive behavior
Psych Social
Clinically depressed and
Psych Social
requires repeated
encouragement to complete ADL
activities.
Requiring extensive interactive
Results: Documents
discussion to assist in decisionmaking related to DNR status or Nursing Progress Note
hospice referral
Documentation
Specifics
Subjective/Objective assessment
and Interventions
Restraint documentation
Subjective/Objective assessment
and Interventions
Subjective/Objective assessment
and Interventions
Care Manager note
Specifics of Care Conference
10 Behavior/Emotional
Management-1 hour
Application
Documentation
Location
Documentation
Specifics
Severe anxiety calling for
assistance every 15 to 30
minutes for the majority of the
classification period.
Psych Social
Subjective/objective assessment
and interventions
Dementia calling out disruptively
who requires intervention to
manage behavior every 1 hour
for the majority of the
classification period
Family member seeks out the
patient’s RN for inappropriate
requests every 1 hour for the
majority of the classification
period.
Patient with bed check going off
frequently
Psych Social
Ad hoc additional times in and
out of room
Subjective/objective assessment
and interventions
Psych Social
Observation of Family
Interactions
Psych Social
Ad hoc frequency of bed check
Safety Management
Indicators
Select only one indicator 1112 (if applicable)
11 Safety Management: every1 to
2 hours: Select for a patient who
is at risk of harm to self or others,
requires observation and/or
intervention by a staff member
every two hours or more often for
the majority of the classification
period.
• Can be used for patients with bed
check system
12 Safety Management - every 1530 minutes: Select for a patient
who, due to risk to harm self or
others, requires observation
and/or intervention by a staff
member every thirty (30) minutes
or more often for the majority of
the classification period.
• Patient in soft restraints- must
have documentation completed
• Patient requiring a safety
attendant- must have
documentation completed
11 Safety Management:
every1 to 2 hours
Application
Documentation
Location
Documentation
Specifics
Age, mental status or
behavior pose a risk to
self or others requiring
visual observation every
1 to 2 hours for the
majority of the
classification period.
Fall Risk, bed or chair
alarm
Psych Social
Subjective/objective
assessment and
interventions
Fall Risk Assessment
Score of 6 or greater
Bed/Chair Alarm
12 Safety Management every 15-30 minutes
Application
Documentation
Location
Documentation
Specifics
Soft or leather restraints
requiring visual observation
every 30 minutes or more
often for the majority of the
classification period.
Age, mental status or
behavior pose a risk to self
or others requiring
observation every 30
minutes or more often for
the majority of the
classification period
Continuous observation by a
staff member /safety
attendant for the majority of
the classification period.
Restraint Assessment
Restraint documentation
Fall Risk Assessment
Score of 6 or greater
Psych/social behavior
documentation
Subjective/objective
assessment and intervention
Special Needs / Safety
Safety Attendant at bedside
Isolation Indicators
13 Isolation Precautions: Select for
a patient who, due to known or
Application
suspected risk for transmissible
infection or susceptibility to
transmissible infection, requires Any Isolation
additional precautions beyond
Precautions
Standard Precautions
• Appropriate for Airborne,
Neutropenic, Droplet,
Enteric/Contact precautions
• Document type of isolation in
Patient Care Summary
• Not appropriate for latex
precautions
Documentation Documentation
Location
Specifics
Special Needs Infection
/ Safety
Control
Isolation
Physiological Assessment
Indicators
Select only one of the indicators
14-15-16-17 (if applicable)
• The assessment or intervention
rate must be documented for at
least 12 hours
14 Physiological Assessment- q4 hours:
Select for a patient who requires
physiological assessment and/or
intervention every 4 hours or more often
for the majority of the classification period.
15 Physiological Assessment- q2 hours:
Select for patient who requires
physiological assessment and/or
intervention every 2 hours or more often
for the majority of the classification period.
16 Physiological Assessment- q1 hour:
Select for a patient who requires
physiological assessment and/or
intervention every 1 hour or more often for
the majority of the classification period.
17 Physiological Assessment- q30
minutes: Select for a patient who
requires physiological assessment and/or
intervention every thirty (30) minutes of
more often for the majority of the
classification period.
14 Physiological Assessmentq4 hours
Application
Vital signs, and / or
assessments
Documentation
Location
I View
Documentation
Specifics
Vital signs, cardiovascular-pulmonaryneuro-fluids- wound
sites & pain
assessments
Fluid Assessment: I&O, Drain output, Peritoneal dialysis, Bladder Scanning
Medication Assessment: PCA response, Blood glucose, Administration of
medications q 4 hours
Pulmonary Assessment: Respiratory rate or O2 sat, Suctioning, Respiratory
treatments
Cardiovascular Assessment: Pulse rate, heart rhythm, and/or BP, Doppler of pulses
Neurological Assessment: Neuro checks
The assessment or intervention rate must be documented for at least 12 hours
15 Physiological Assessmentq2 hours
Application
Documentation
Location
Per ACC Assessment
I View
Standard or physician
orders
Turning every 2 hours by
staff for skin needs
Musculoskeletal
Documentation
Specifics
Vital signs, neuro checks,
vascular checks, sheath
checks, Endotool
Repositioning
Fluid Assessment: I&O, Drain output
Medication Assessment: PCA response, Blood glucose, Administration of
medications q 2 hours
Pulmonary Assessment: Respiratory rate or O2 sat, Suctioning
Cardiovascular Assessment: Pulse rate, heart rhythm and/or BP, Doppler of pulses
Neurological Assessment: Neuro checks
The assessment or intervention rate must be documented for at least 12 hours
16 Physiological Assessmentq1 hour
Application
Documentation
Location
Documentation
Specifics
Per Physician orders or
patient requirements
I View
Vital signs, neuro checks,
vascular checks, sheath
checks, Endotool
Fluid Assessment: I&O, Drain output
Medication Assessment: Drip titration (Dopamine, Insulin, Propofol), Epidural
infusion, Administration of medications q 1 hour
Pulmonary Assessment: Respiratory rate or O2 sat, Suctioning
Cardiovascular Assessment: Pulse rate, heart rhythm and/or BP, Doppler of pulses,
VAD, IABP, CRRT/CVVH/Aquapheresis
Neurological Assessment: Neuro checks, ICP monitoring
The assessment or intervention rate must be documented for at least 12 hours
17 Physiological Assessmentq30 minute
Application
Documentation
Location
Documentation
Specifics
Titrating medication
I View
Vital signs, neuro checks,
vascular checks, sheath
checks, Endotool
Fluid Assessment: I&O, Drain output
Medication Assessment: Drip titration (Dopamine, Insulin, Propofol)
Pulmonary Assessment: Respiratory rate or O2 sat, Suctioning
Cardiovascular Assessment: Pulse rate, heart rhythm, and/or BP, Doppler of pulses,
VAD, IABP, CRRT/CVVH/Aquapheresis
Neurological Assessment: Neuro checks, ICP monitoring
The assessment or intervention rate must be documented for at least 12 hours
Medication Preparation >20
Indicator
Application
18 Medical Preparation > 20
minutes: Select for a patient
who requires preparation of
medication(s) or preparation
to administer medication(s)
requiring twenty (20) minutes
or greater of continuous staff
time.
Documentati Documentati
on Location on Specifics
Medication
MAR
preparation that
takes 20
I View
minutes or
longer: Insulin,
blood
administration,
chemotherapy,
Tubing change
day, epidural
drips,
TPN/lipids
TPN/Lipids
IV assessment
Tubing change
Drip changes
Blood products
task
I&O
Wound/Injury Management
Indicators
Select only one indicator 19-20
(if applicable)
19 Wound/Injury Management: Select
for a patient who requires an
assessment and/or intervention of a
wound/injury site.
20 Wound/Injury management > 30
Minutes: Select for a patient who
requires continuous wound/injury site
intervention for thirty (30) minutes or
greater.
Wound/Injury Management
Application
Documentation
Location
Documentation
Specifics
Central line IV or arterial line IV Assessment
dressing changes
Stoma care
GI Detailed
Intervention
Drsg Change Due
GI Ostomies
PEG Care
GI Detailed
GI Input Tubes
Trach care
Artificial Airway
Tracheostomy Interventions
Chest tube dressings
Respiratory Detailed
Chest Tube Assessment
GI bleed patients
GI Detailed / I & O
GI output tubes, I & O
Wound VAC assessments
Skin Detailed
Wound Tube Assessment
Wound / pressure ulcer
dressing changes
Incision site
Skin Detailed / Pressure
Ulcer
Skin Detailed
Wound Assessment /
Pressure Ulcer Assessment
Wound Assessment
19 Wound/Injury Management: Select for
a patient who requires an assessment
and/or intervention of a wound/injury
site.
Wound/Injury Management >
30 Minutes
Application
Documentation
Location
Documentation
Specifics
Sheath Removal
Sheath / IABP Removal
Sheath assessment
Wound VAC dressing
change/ packing
Debridement of wounds
Skin detailed
Wound Tube Assessment
Skin detailed
Wound Assessment
Extensive Burn dressings Skin detailed
Wound Assessment
Multiple dressing
changes-3 sites of 15
minutes duration each
Wound Assessment
Skin detailed
20 Wound/Injury Management > 30
Minutes: Select for a patient who
requires continuous wound/injury site
intervention for thirty (30) minutes or
greater.
Healthcare Management
Education ≥ 1 hour
21 Healthcare Management
Education >1 hour: Select for a
patient who requires
individualized education of one
(1) hour or greater cumulative
duration to address the
knowledge and/or procedures
that will be necessary for postdischarge healthcare
management. A current plan with
objectives for teaching/learning
exists, and the patient is able to
understand and respond to the
education.
• Also applies to the patient’s
family, caregiver, or significant
other.
Applicati
on
Documen Documen
tation
tation
Location Specifics
Applies if
education
provided by
RN,PT, OT,
SLP, MSW,
VAD
educator,
transplant
educator,
joint
education,
etc.
Patient
Education
PT/OT
progress
note
Care
manageme
nt progress
note
Patient
Education
1 to 1 Physiological
Intervention > 2 hours
Application Documenta Documenta
tion
tion
Location
Specifics
Example:
CRRT, VAD,
ECMO, Burn,
Severe
Sepsis,
Unstable
Admission
22 1 to 1 physiological
intervention > 2 hours: Select
for a patient who, due to
physiological instability, requires
continuous 1:1 or greater (e.g.,
2:1)
• RN assessment and/or
intervention at the bedside for 2
(two) hours or greater.
• This will typically be an ICU
patient or patient waiting for bed
availability for transfer to ICU
Credit for Procedures
 We are able to take ‘credit’ for different inpatient
procedures or activities lasting greater than 1
hour that effect our staffing.
 As with the other acuity scoring, there must be
documentation to back up what is put into the
acuity classification system.
 The procedure time must be AT LEAST one
hour in length.
 The actual hours (start and stop times)
associated with these ‘procedures’ must be
documented in Acuity Plus as well! (it will default
to one hour)
Credit for Procedures
Credit for Procedures
Documentation:
Procedure (start) and
Departure (end)
Add
Credit for Procedures
MOST COMMONLY USED
1:1 safety observation by non-RN is for
patients who, due to risk to harm self or
others, requires one-to-one continuous
non-RN observation. This is what is
used for sitter cases.
Off unit accompanied by RN is for a
patient who requires dedicated one-toone RN caregiver to accompany the
patient off unit for one hour or greater.
Does not apply for a patient who
requires 1:1 RN care on the unit.
1:1 by RN is for a patient undergoing a
bedside procedure who requires
dedicated one-to-one care by an RN for
one hour or greater. Does not apply for
a patient who requires 1:1 RN care on
the unit.
Procedure Indicators
Application
Documentation Location
Documentation Specifics
1:1 safety observation by a nonRN
Off unit accompanied by RN,
includes pack up and end time.
CANNOT use for 1:1 patient
Off unit accompanied by non-RN
Use for any patient accompanied
only by NT
Patient/Family education by RN
(continuous education > 1 hour)
Extensive wound management for
1 hour or greater (Burn dressing or
large VAC dressing change)
Coordination of care by RN.
(coordinating transfers, multiple
consults) takes > 1 hour. (care
conferences)
1:1 by RN. Procedures. Patients
requiring > 1 hour but less than 2
hours.
2:1 by RN.
Special Needs Safety
Safety attendant
Patient Activities and Events
Note time patient left unit and the
destination. Note time returned to
unit
Note time patient left unit and the
destination and transported by NT.
Note time returned to unit
Patient Education and comment re
length of time
Wound assessment (include times)
Patient Activities and Events
Patient Education
Skin Detailed
Patient Activities and Events?
Include the amount of time spent
coordinating >1 hr.
Patient Activities and Events
Include start and stop time
Patient Activities and Events
Add comment in Patient Events
the need for 2:1 nursing care.
Credit for Procedures
***Once you have documented a ‘procedure’ in
Acuity Plus, you will continue to see a ‘P’ under
the Proc heading until discharge. It will be a
dark ‘P’ on the day it was entered and will be
dithered out after that.
***On nights, the charge nurses are able to help
input the necessary procedure data! Get credit
for those procedures that happen on the night
shift (i.e. MRI’s, etc!!!).
Quality Data Metrics
These indicators are for
quality data.
These also must have
documentation in
CERNER that supports
classification.
Used for Nursing
Sensitive Indicators
measured in NDNQI
dashboards.
Good-Bye
Let’s play some Jeopardy!
Thank you