UT-Harris County Psychiatric Center
Nursing Procedures

Patient Acuity

Nursing

Harris County Psychiatric Center: Office Administration

Sufficient nursing staff is required to work on the units to provide quality care for each patient and ensure a safe milieu. To accomplish this, Nursing uses a patient acuity rating system to forecast staff allocation on a shift-by-shift basis

acuity, level of care, staffing, precautions

The University of Texas Health Science Center at Houston

Introduction	Date of Last Review: 5/19/08 SME: Associate Director of Nursing Sufficient nursing staff is required to work on the units to provide quality care for each patient and ensure a safe milieu. To accomplish this, Nursing uses a patient acuity rating system to forecast staff allocation on a shift-by-shift basis.
Who assigns acuity ratings?	Each shift, the shift leader or designee assigns each patient an acuity rating for the oncoming shift.
Patient acuity ratings	The table below indicates the levels of care and the acuity rating for each type of care provided:
	Level of Care	Acuity Rating	Type of Care
	High Intensive	4.0 4.2	1:1 Supervision/Observation 1:1 Supervision/Observation Continuous
	Intensive	3.1	10 foot Restriction
		3.1	Special Observation
		3.1	Suicide Precaution
		3.1	Elopement Precaution
		3.1	Sexual Acting-Out Precaution (SAO)
		3.1	Combative/Destructive Precaution
		3.1	Direct Observation
		3.2	Medical problem/symptoms requiring a high number of nursing care treatments Examples: Acute detoxification, unstable vital signs – tachycardia, unstable blood sugar, chest pain, change in mental status, etc.
		3.3	Seclusion
		3.4	Restraint
	Modified Intensive	2.0	Assistance with activities of daily living (partially dependent)
		2.1	Active audio/visual hallucinations
		2.2	Medical problems requiring a moderate number of nursing care treatments Examples: Wound care, monitoring for: blood sugar, blood pressure, fetal heart tones, neuro vital sign, etc.
		2.3	Frequent redirection for behaviors as follows: impulsive, intrusive, agitated, confused, disorientation, and threatening/abusive
		2.4	Escorting requirements for greater than 2 hours
		2.5	Special Observations
	Intermediate	1.0	Awaiting discharge
		1.1	Requires only routine monitoring
		1.2	Requires prompting, but is generally cooperative

Acuity Rating related to Medical Problems

An RN manages any patient with an acuity rating of 3.2 (acute medical problems/symptoms) to include, but not limited to:

1.0 Rounds

2.0 Vital sign monitoring

3.0 Documented assessment a minimum of every 2 hours (relevant to medical symptomatology)

Online Nursing 24-Hour Report

The Registered Nurses documents acuity utilizing the online Nursing 24-hour Report. Refer to online Help Manual needed.

1.0 Records acuity rating for each patient

2.0   The charge nurse is responsible for reviewing and indicating that the document is   complete by checking the complete prompt. This process must be completed 3   hours prior to the beginning of the next shift as follows:

2.1	Day(s) by noon
2.2	Evening(s) by 8:00pm
2.3	Night(s) by 4:00am
2.4	7a-7p by
2.5	7p-7a by

Duties of Staffing Coordinator/ Nursing Supervisor

The Staffing Coordinator/Nursing Supervisor in collaboration with the Nurse Manager adjusts staffing in accordance with acuity calculations.

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