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Shannon Terrell

Nursing Informatics 410


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

and benefit both patients and employees. My proposal is to implement new

policies that use informatics such as, acuity tools and MEWS to supply efficient

staffing to the unit and optimize patient care and safety.


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

in patient acuity and provided support to empirically substantiate these claims.

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


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.

BCMA and MEWS are 2 other extremely valuable informatic components to

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

verifying the medication for a first check before administering to patient.

("Workarounds to Barcode Medication Administration Systems: Their Occurrences, Causes, and

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

work-stations in the interest of saving time. ("Workarounds to Barcode Medication

Administration Systems: Their Occurrences, Causes, and Threats to Patient Safety," 2008) These

negligent practices can result in medication errors and impede patient safety and


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

declining patient on a busy night is the MEWS, or Modified Early Warning

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

fast in the best interest of the patients’ outcome.

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


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

“almost” error free environment for our patients and staff.

When I began this project, I struggled to find a topic that I could identify

with my unit, as well as find sufficient evidence-based research. After exploring

this staffing issue, I feel that I could take my findings to the next shared


governance meeting and present the proposal of more staffing and a proper PCS

that will assist us in this scheduling process.


Workarounds to Barcode Medication Administration Systems: Their Occurrences,

Causes, and Threats to Patient Safety. (2008, July 1). Retrieved from

Nurse Staffing and Patient Outcomes : Nursing Research. (n.d.). Retrieved from


Patient Acuity - Patient Safety and Quality - NCBI Bookshelf. (n.d.). Retrieved