health care monitoring system nurse staffing module how to
TRANSCRIPT
Version 1.1 (October 2018)
Health Care Monitoring
System
Nurse Staffing Module
How to Guide
How do I measure patients’ levels of acuity?
The ward sister/charge nurse is responsible for ensuring that the social, psychological,
spiritual and physical care needs are assessed and classified using the Welsh Levels of
Care descriptors.
The Welsh Levels of Care consists of 5 levels of acuity ranging from Level 1 where the
patient’s condition is stable and predictable requiring routine nursing care, to Level 5
where the patient is highly unstable and at risk requiring an intense level of continuous
nursing care on a 1:1 basis.
How do I use the Welsh Levels of Care?
Please refer to the Welsh levels of Care document on how to assign the right level of care
to the patients available on the following link:
http://www.1000livesplus.wales.nhs.uk/sitesplus/documents/1011/Published%20Welsh%2
0Levels%20of%20Care%20%20edition%201.%20English%20version..pdf
How do I collect the data?
The data is required to be collected directly onto the Health Care Monitoring System
(HCMS), which is the All Wales repository for the collection of this data. The following
explains how to do this.
Accessing the Nurse Staffing Module on the Health & Care Monitoring System
(HCMS)
The information can be collected using a personal computer (PC) or via a mobile tablet
device.
Step 1: Access the Health & Care Monitoring
System log in page (see Figure 1). If the
system is unavailable or due to operational
pressures the acuity audit scores cannot be
entered directly onto the HCMS at the time of the
assessment, then there is a data collection form
that can be used to gather the data in exceptional
circumstances (Appendix 1). Any data collection
sheets must be retained for one year (refer to
your HB retention and destruction of records
Figure 1: HCMS login screen Tablet
device view
policy for further information).
Step 2; Select the Nurse Staffing module
(see Figure 2).
The acuity assessment is assessed by
selecting the Nurse Staffing option from the
menu.
Figure 2: HCMS module selection screen
Entering a new assessment on the Nurse Staffing Module on the Health & Care
Monitoring System (HCMS)
It is very important that the information entered is accurate and quality control is the key to
successful data collection.
The registered nurse undertaking the assessment is responsible for entering the data onto
the Nurse Staffing Module of the HCMS. The assessment will be undertaken on a daily
basis.
All registered nurses undertaking the assessment should be experienced in making
decisions around a patient’s acuity and be able to complete, to a consistent level, the daily
acuity assessments required. The ward manager needs to ensure that all the staff share a
general consensus on which patients would fall into each level.
What must I remember when participating in the acuity audit?
The following simple steps will ensure a consistent approach across participating wards:
The data collection will take place, at minimum, twice per year: 1st - 31st January
and 1st – 30th June (however, some HBs have decided undertake the acuity audit
on a more regular basis).
Data must be recorded on every patient, 7 days a week, for the full calendar month
for the period of the acuity audit. It is essential that data is captured every day of the
audit period to ensure that there is accurate information on which to base the
decisions on what the nurse staffing level needs to be for that ward;
Level of care scores should reflect the acuity of each patient in each bed at
1500hrs;
A numeric value needs to be entered into every box. If there is no patient in the bed
then the number zero needs to be entered into the box otherwise it will show up as
no data;
Comments are important to provide a rationale for some of the decisions being
made at ward level and it is recommended that at minimum comments are entered
for all level 4 and level 5 patients, however, all comments entered will help to inform
the patient acuity on the ward;
Any acuity data completed in the nurse staffing module but not validated by the
ward manager will be flagged as part of the monthly sign off process; and
The ward manager will need to validate the data before completing the sign off
process.
The audit is comprised of three sets of information:
Ward activity
As part of the data collection process in the HCMS, Ward activity data should be collected
for the previous 24-hour period from the start of the early shift the day before to the end
of the night shift on the morning of the acuity assessment. Ward staff will be prompted to
input a daily total of the number of ward attenders and the number of escorts on and off
site during the 24 hour period from the start of the early shift for the previous day until the
end of the night shift on the morning of the acuity assessment (figure 3)
In addition, patient flow data is collected to provide a fuller picture of activity within the
ward. Details of admissions, discharges, transfers and deaths will be gathered from the
organisation’s Patient Administration System (PAS) and entered in accordance with your
HB processes.
Figure 3: HCMS screen for the capture of ward attenders and escorts on and off the
ward.
Staffing deployed
The total number of actual staffing hours needs to be collected each day for the 24 hour
period commencing the start of the early shift the day prior to the assessment and up until
the end of the night shift on the day of the acuity assessment. Actual nursing staff refers
to the staff on duty during this 24 hour period. This data is collected by the registered
nurse undertaking the assessment and should be entered onto the HCMS for the
previous 24 hours (Figure 4). The total number of staffing hours worked during the 24
hour period under assessment is broken down as follows:
Core registered nursing staff hours – i.e. registered nurses who are on the ward establishment and working their core hours;
Core healthcare support worker hours – i.e. healthcare support workers who are on the ward establishment and working their core hours;
Registered nursing supplementary hours worked by core staff in addition to their core hours;
Healthcare support worker supplementary hours worked by core staff in
addition to their core hours;
Registered nursing bank hours worked;
Healthcare support worker bank hours worked;
Registered nursing agency hours worked; and
Healthcare support worker agency hours worked.
Figure 4: HCMS screen for the capture of staffing hours information.
Patient acuity
For each patient occupying a bed on the ward, an assessment is made of the level of care
they require as at 15:00 hrs (or for paediatrics, as agreed within your HB); some areas are
required to undertake the acuity audit more than once a day. Each patient is assigned a
level of 1, 2, 3, 4 or 5 based on the Welsh Levels of Care. This data, where possible,
should be entered directly onto the HCMS at the time of the audit by the registered nurse
undertaking the acuity assessment (Figure 5).
All registered nurses should be experienced in making decisions around a patient’s acuity
and be able to complete, to a consistent level, the daily acuity assessments required. The
ward manager needs to ensure that all the staff share a general consensus on the tyoe of
patients that would fall into each level.
The registered nurse undertaking the assessment is responsible for entering the data onto
the Nurse Staffing Module of the HCMS. The assessment will be undertaken on a daily
basis. Where possible, acuity assessments should be entered directly into the HCMS at
the time of the assessment. In exceptional circumstances, paper assessment forms can be
used but these need to be inputted onto the HCMS, at a minimum, on a weekly basis.
Data collection sheets must be retained for one year (refer to your HB retention and
destruction of records policy for further information).
The levels are colour coded in accordance with the Welsh Levels of Care. Comments are
important to provide a rationale for some of the decisions being made at ward level and it
is recommended that, at minimum, comments are entered for all level 4 and level 5
patients. However, all comments entered will help to inform the patient acuity on the ward.
Ensure all the data fields are completed with a numeric value and the information is
accurate (If there is no patient in the bed then the number zero needs to be entered into
the box)
It is very important that the information entered is accurate and quality control is the
key to successful data collection.
Figure 5: HCMS acuity assessment screen.
Staffing Decisions screen
For each day the staffing decision screen needs to be completed. The first question which
appears will be “Was the number/skill mix of nursing staff on duty during last 12/24 hours
as per the planned roster? The planned roster is the agreed nurse staffing level agreed by
the Designated Person for the Health Board/Trust (usually the Director of Nursing). If the
planned roster is RN x 3 and HCSW x 3 then any deviation from this means that the
answer to this question is 'NO' e.g. 4 RN and 2 HCSW, 2 RN and 4 HCSW 3 RN and 4
HCSW (figure 6).
Figure 6: HCMS acuity staffing decisions screen
If the response is ‘YES’ to this question then you click ‘next’ (figure 7) and move on to save
and complete the assessment
Figure 7: HCMS acuity staffing decisions screen
If the response is ‘NO’ then the question “Was it an active decision to vary the planned
roster, which was appropriate to enable to needs of the patients to be met?” will appear
(Figure 8)
Figure 8: HCMS acuity staffing decisions screen
If the response is ‘YES’ then two additional questions appear (figure 9). Please complete
and then select ‘next’ and move on to save and complete assessment. Please note any
additional comment in the comments boxes.
Figure 9: HCMS acuity staffing decisions screen
If the response is ‘NO’ then two different additional questions appear (Figure 10). For the
first question tick all that apply from the pre-populated list and enter any additional
information in the comments box.
Then complete the second question regarding incident occurrence /recording and then
select ‘next’ and move on to save and complete assessment.
Figure 10: HCMS acuity staffing decisions screen
Please note that the questions marked with an asterisks MUST be completed before you
select ‘next’. If the ‘next’ box is selected before all the questions marked with an asterisk
are complete then the below message will appear (Figure 11).
Figure 11: HCMS acuity staffing decisions screen
Save and Complete Assessment
As the Registered Nurse completing the assessment you will be asked to save the
assessment (Figure 12).
Once the assessment has been saved, the ward manager is required to validate the data
and complete the assessment. The data will then be imported into the Staff & Resources
module of the HCMS.
Figure 12: Save and Complete Screen:
Validation & Sign Off
It is very important that the information entered is accurate and quality control is the
key to successful data collection (see Appendix 2 for the biannual acuity validation
checklist).
The Ward Manager and Senior Nurse/equivalent should review and validate the acuity
assessments on a weekly basis.
The ward manager and senior nurse are responsible for regularly reviewing and validating
the acuity assessments during the month and then for signing off the complete data for the
whole month by the tenth working day of the following month.
Any acuity data completed in the nurse staffing module but not validated by the ward
manager will be flagged as part of the monthly sign off process. The ward manager will
need to validate the data before completing the sign off process.
Ward Managers and Senior/Lead Nurses should ensure that further discussion of the
results takes place at the earliest opportunity following validation/sign off.
Ward Management Module
The information in the Ward Management module needs to be updated as and when there
are changes on the ward e.g. change in specialty, number of beds, funded establishment,
planned roster. To access the ward management module click on your ward name on the
overview page and the screen in Figure 13 appears. Ward Managers need to ensure that
this information is kept up to date and reflects what has been agreed with the ‘Designated
Person’. Click update to complete.
Ward Specialty: Enter the ward specialty - at minimum select general medical or general
surgery.
Number of Beds: Enter the number of beds in use. For some wards this might vary from
day to day.
Planned Roster: Enter the planned roster for the ward per day of the week. At minimum
the number of hours for the 24 hour period must be entered although this can be broken
down by hours on an early, late and night duty, if required.
If the nurse staffing module information is being captured once a day then the total hours
for the 24 hour period must be entered in the early shift boxes and the remaining boxes left
blank. The additional boxes have been added for those wards capturing the nurse staffing
level module information more than once a day e.g. paediatric wards.
If the nurse staffing module information is being captured twice a day then the planned
roster for the daytime period can be entered under the ‘early’ and the planned roster for
the night time period can be entered under the ‘night’ box. Where a single, ‘long day’ shift
is being worked then these hours would be included under the early shift.
If the nurse staffing level information is being captured three times a day then the planned
roster for each shift would need to be entered.
Figure 13: Ward Management Screenshot.
Appendix 1: Acuity data collection form All Wales Nurse Staffing Programme:
Acuity Audit Data Collection Form
Bed 1 2 3 4 5 Ward Name
1
2
3 Site Name
4
5
6 Audit Date & Time
DD MM YY HR 7
8
9 Ward Activity: provide total number of instances for the 24 hours period from the start of the Day Shift the day before to the end of the Night Shift on the day of the acuity assessment:
10
11
12 Ward Attenders
13
14 Escorts on Site
15
16 Escorts off Site
17 Actual Staffing Hours: Provide the total number of hours for the 24 hour period from the start of the Day Shift the day before to the end of the Night Shift on the day of the acuity assessment:
18
19
20 RN HCSW
21 Core Staff
22 RN HCSW
23 Bank
24 RN HCSW
25 Agency
26 RN HCSW
27 Supplementary
28 NB. Supplementary figures should include any additional hours worked on your ward by core staff, beyond their established hours and/or any clinical hours worked by the Ward Sister . Do not record this extra time in the core staff category. The figures should also include staff that are borrowed from other areas.
29
30
Comments Completed By
Signature
Version 2.1 (June 2019)
Appendix 2: Bi annual audit validation checklist
Action
1 During January/June complete the ward management module on HCMS with the
required information
2 Complete the assessment for every day during the month of January/June .
3 Ensure the following data is entered correctly on the nurse staffing module of the HCMS
on a weekly basis:
Enter the date and time of the assessment
Acuity data: use the Welsh Levels of Care to measure the acuity and dependency
of each patient occupying a bed at 3pm.
Provide rationale for the acuity of patients, particularly for level 4 and 5 patients.
Enter the total number of ward attenders/escorts off site for the 24 hour period from the start of the day shft the day before to the end of the night shift on the day of the assessments eg: 7am-7pm.
Enter the number in hours the actual number of core and supplementary staff deployed from 7am the day before to 7am on the morning of the assessment.
(Note: supplementary staff includes any hours worked by core staff above their contacted hours (eg: staff working additional hours or full time staff working overtime), staff from other areas and staff working bank and agency shifts.
4 Ensure all the data fields are completed with a numeric value and the information is
accurate.
5 Ward Managers and Senior Nurses to review and validate the acuity assessments on a
weekly basis during the month.
6. Ward activity data is uploaded as per Health board process
7. Senior Nurse or equivalent as identified by the health board to validate and sign off the
assessment as being complete and accurate by the 10th working day of the following
month
8. Provided that the data is accurate, PHW to return visualizer reports by 20th working day
of the following month
9. Ward Managers, Senior Nurses and Lead nurses should ensure that further discussion
of the results takes place at the earliest opportunity following validation/sign off.