Development of an acuity scale for the inpatient hospice setting: a quality improvemtent project

Abstract

Background: Nurse burnout and care fatigue are troubling, prevalent issue within our medical community. Research has shown that high acuity and inequitable staffing assignments contribute to the problem. No streamline solutions have been proposed in the literature. Patient safety events such as falls, and medication errors have been shown to be interrelated to nurse burnout. Balancing workload and patient demands are essential in promoting safe care environments. A 21-bed hospice unit in North Idaho recognized this correlation and requested help in developing an acuity scale to promote nurse to patient staffing equitability thus lessening care burden. Method: A literature review reviled numerous articles promoting staffing balance to stave off care fatigue. Acuity scales are an efficient, concise way to quantify workload and promote balanced staffing assignments. Staff surveys were conducted prior to and post implementation of the tool to measure staff assignment satisfaction. Data was collected on fall rates and medication errors to detect correlation between the two factors. Intervention: Only one published hospice specific acuity scale was identified in the literature review done for this project, Mary Potter Hospice Acuity Tool. A unit specific tool was developed based of the framework provided by this published scale. The acuity tool was trialed on fifty new admissions into the hospice unit between February and March 2023. Results: Limited data was collected as the implementation phase of the project was delayed due to IRB approval and facility specific setbacks. The marginal data collected demonstrates nurse assignment satisfaction improved post intervention while fall rates and medication errors actually increased. Conclusion: This projects objectives were not fully realized due to the previously mentioned delays. The data collected was minimal and greatly impacted. This project provides a solid framework for future developments in unit specific acuity tool development. Future projects such as this one would benefit from a larger timeframe in which to revise the tool being developed and facilitate better impact on the metrics being studied.