Patient Classification system and staff scheduling

Management topic
By :- Riddhi Dodiya Makwana

1. CREATED AND PRESENTED BY. DODIYA RIDDHI NILESH ROLL NO. 03 PATIENT CLASSIFICATION SYSTEM AND STAFF SCHEDULING

2. PATIENT CLASSIFICATION SYSTEM

3. The patient classification system (PCS), also known as patient acuity system. It is a tool used for managing and planning the allocation of nursing staff in accordance with the nursing care needs. Thus, PCS is used to assist nurse leaders determine workload requirements and staffing needs. INTRODUCTION

4. “ The patient classification system (PCS) groups patient as per the complexity and amount of their nursing care necessities.” DEFINITION

5. The intention of PCS is to evaluate patients, group them with other patients having similar needs and attribute patients in different groups. As it is a numerical way of measuring the nursing care needs of patients, number alone have proven to be a faulty way of finding out nursing care assignments. INTENTIONS OF PCS

6. Since, other variables within the number system that affects the nursing care hours, it is usually not possible to shift a PCS from one facility to the other. Although companies marketing a PCS propose an appropriate number of hours of care for each classification, each institution should make the final decision concerning the number of nursing care hours alloted . CONTI……

7. Williams (1998) suggests that it is a mistakes for managers to think that PCSs will solve all staffing problems. Standard units of measurement need to be reviewed periodically and adjusted if necessary. The organizations hours alloted for each category or classification of patients may not be sufficient or its classification system may prove to be inaccurate. CLASSIFICATION ACCORDING TO THE NUMBER OF HOURS ALLOTED

8. The middle-level manager must be carefully to both internal and external forces that affects unit requirements. This may not be reflected in the organization patient care classification system. This does not imply that the unit manager should be not held accountable for the standard unit of measurement, but rather, he can be cognizant of justifiable reasons for overstaffing or understaffing. CONTI……

9. Patient classification, staffing, scheduling and strategies used in the delivery of patient care, all reflect sensitivity to cost containment, length of hospitalization and improvement of patient care. CONTI…..

10. The PCS provides a method of quantitatively estimating and assessing patients needs in relation to nursing care. It is a way of determining the amount and type of care of patients require as well as providing a mean of standardizing nursing care practice. As economic issues have become important, health care decision making and the PCS provide an input to how nursing care is delivered, the amount of time required, the amount of time required, the cost involved, they also evaluate cost-effective care. IMPORTANCE OF PATIENT CLASSIFICATION SYSTEM

11. The PCS can be used as a valid and reliable instrument to measure the acuity level of patients in terms of nursing workload and number of nursing staff needed, as well as variations in nursing care. This helps to simplify staff allocation and scheduling. This system can also be used effectively for long-range staffing, budgeting, management planning, quality management programes , compliances with licensing and industry standards and regulations. CONTI…….

12. Factor evaluation system. Common care discriptor . Diagnostic related groups. TYPES OF PCS

13. Patients needs are scored on multiple care descriptors. Most of the health care agencies use this PCSs where several care elements or descriptors are identified. Each elements is divided into sub-elements and a standard time is determined for accomplishing each sub-elements. FACTOR EVALUATION SYSTEM

14. The descriptors used to measure the patients dependency needs are activities of daily feeling, grooming, toileting, comfort measures and mobility. The requirement to assist a patients with each activity is quantified from the least amount of time required to the greatest amount of time required. Eg :- Self-feeding vs tube feeding. CONTI….

15. It describes typical patients and their varying need levels. Eg :- hygiene, nutrition, medications etc. After care descriptors have been selected, the levels of care and intensity are defined for each descriptors. The factor system can be cited as objectives because mentioning special indicators or factors linked up with patient care facilities to as certain objectivity by the rater. COMMON CARE DESCRIPTORS

16. The prototype evaluation system is regarded as subjective. It uses broad descriptive categories to report the patients and his/her requirements some features are listed in categories. CONTI……

17. CATEGORY = 1 CATEGORY = 2 CATEGORY = 3 CATEGORY = 4 CATEGORY = 5 CATEGORIES

18. Patients with acute illness will have their illness reversed, the main goal being to counter their illness so that it subsides and restore their health. CATEGORY = 1

19. Patient diagnosed with chronic illness but had an acute illness will be treated completely to reduce the disability and complication in the level. The family members will be given help in managing the patients so that he/she returns to a normal life after the irradication of the illness. CATEGORY = 2

20. Patients diagnosed to have disability due to chronic diseases but having the possibility to return to the optimum level of functioning through rehabilitation methods with the help of the health agency, supported by the hospital. CATEGORY = 3

21. Patients diagnosed with chronic illness who cannot be cared for by family members since the disease has resulted in complications and thus would need constant hospital support. CATEGORY = 4

22. Patients are in the terminal stage of their illness and require specific team members to rescue them from death, therefore the PCS system plans the care specific to each category of illness. CATEGORY = 5

23. This is grouping patients for prospective payment. This system sets a pre- determind price for patients hospital care of medicare recipient according to placement in 1 of 467 diagnostic related groups. The DRG system is a strategy for grouping patients according to demographic diagnostic and therapeutic characteristics that correlate with their use of hospital facilities. DIAGNOSTIC-RELATED GROUPS

24. Under the prospective payment system, hospitals are paid a fixed price for all inpatients, according to the DRG into which they are classified at the time of discharge from the hospitals. If the hospitals cost for the patients care is less than the fixed rate, the hospital makes a profit. If the cost exceeds the fixed rate , the hospital is at a loss. The DRG system provides incentives for early hospital discharge but the quality of care is affected. CONTI……

25. INTRODUCTION In nursing management of any unit, time planning for the worker is a pre-requisite for successful nursing operations because the scheduling of working and non-working hours directly effects the employees productivity work satisfaction and job tenure. SCHEDULING / DUTY ROASTER

26. “Scheduling is defined as a pattern of on-off duty hours for employees in a particular unit. DEFINITIONS

27. Many different approaches to nurse staffing and scheduling are being tried in an efforts to satisfy the needs of employees and meet workload demands for patient care. This includes the game theory, modified work weeks (10-12 hours shift), team rotation, premium day and weekend nursing staff. APPROACHES

28. Such approach should support the underlying purpose, mission, philosophy, objectives of the organization and the division of nursing and should be well defined in a staffing policy and philosophies. CONTI……

29. To provide quality of nursing care by appropriate staffing and avoiding excess staff workload. To be fair in providing equal distribution of days off all staff while scheduling work. To avoid confusion in work environment which helps the staff to complete the task appropriately on time. PURPOSE

30. To help the staff to learn their work schedules in advance so that they can streamline their work accordingly. To accomplish the goals of the nursing management unit. To help the staff handling emergency situation by adding staff from less busy unit. CONTI……

31. PRINCIPLES OF PLANNING DUTY ROASTER Coverage Continuity Flexibility Stability Cost effectiveness

32. MODIFIED WORK WEEK This approach includes 10 hour and 12 hour shift. Other methods are commonly used, but the nurse administrator who schedules the work should be familier with the staffing philosophies and policies, and the scheduling using unit suits the work environment by providing nursing care and fulfilling the goals of the nursing care in general. METHODS OF SCHEDULING

33. The staff work for 10 – h duty shifts per week with 6-h of overlapping. Those overlapping hours are utilized by planning staff welfare programe and patient – centered conference, which benefits the staff. 10 HOUR SCHEDULING

34. The nurse works for 12h for seven shifts in 2 weeks, has 3 days work and 4 days off in the 1 st week, and 4 days work and 3 days off in the second week. Nurses are paid extra for 84 hour of total work. This type of scheduling helps the nurses to give better nursing care. It also has the added benefits for them as they can save money and manage their personal lives. 12 – HOUR SHIFT

35. This type of scheduling has an advantage of meeting the 5 working days off for their staff who is ready to work continuously in night duty for specific period of time eg :- for 6 months PREMIUM VACATION NIGHT

36. This type of scheduling has an advantage of meeting the staff requirements in the units where the workload is high. In such situations, the staff are scheduled and rotated equally which improves the quality care and job satisfaction. FLEXIBLE ROLE SCHEDULING

37. In this method, weekends are altered so the staff can either use it to attend their continued nursing education programme or they can utilize it for their personnel reasons. Usually nurses work from Monday to Friday and have their weekends off. They work two 12-h shifts and are paid for 40h along with additional benefits. WEEKEND ALTERNATIVES

38. This means continuous rotation of the specific nurse team in a particular unit where each member has to work in a coordinated manner with the team. TEAM ROTATION

39. In this kind of scheduling, one extra day off is given to the staff who offers to work voluntarily for one more extra day apart from the normal scheduled plan. PREMIUM DAY WEEKEND

40. It is one of the flexible scheduling wherein the nurses are cross scheduled to different units, which helps them to get expertise in all areas of nursing unit. But this scheduling requires orientations and ongoing staff development programme to prevent errors in the continuity of the nursing care. CROSS TRAINING

41. Personnel with preference not always match up with planning the duty schedule. Among clinical nurses, this is one major reasons of dissatisfaction. Putting up the normal number of nurses required by a time slot and asking nurses to put colored pins in slots to select their own time can ameliorate satisfaction with the schedule. SCHEDULING WITH NURSING MANAGEMENT INFORMATION SYSTEM

42. State the management objective clearly. Identify the actions required to meet the objectives. Identify the responsible position in the organization. Identify the information required to meet the objectives. Determine the data required to produce the needed information. Determine the systems requirements for processing the data. Develop a flowchart. PROCESS

43. In nursing management planning the duty roster is an important requirements to implement quality nursing care successfully because proper planning and executing of the duty roster. DUTY ROSTER

44. Department policies should guide managers in distributing desirable and undesirable work hours equitably among employees several issues need to be addressed. SPECIFIC SCHEDULING POLICIES IN DUTY ROSTER

45. A policy for a person by little who is responsible for preparing roster. The time period to be covered by each schedule. The number of weeks or days in advance that the roster should be posted. The total of on- duty hours for each employee. The beginning and ending hours of each shift and break times. The number of shifts between each employee must rotate, days off, weekend off, per month and minimum days off ISSUES

46. A skeleton plan is made in pencil to allow alterations. List the names in order to seniority. Put special requests in ink to avoid eraser. Insert days off noting busier days, it is important not to have too many nurses off duty at the same time. Total the number on duty for each staff on each shift. The roster may be planned weekly or monthly or it may be a fixed one. STEPS IN PLANNING THE DUTY ROSTER

47. The nurse in charge should be aware of the holidays allotted to each of the staff nurses who should also be fully aware of the holidays allotted to him or her . Nurses should be encouraged to plan their holidays ahead of time. Only a certain numbers of staff should be allowed to take their holidays simultaneously. HOLIDAYS

48. Use the roaster sheet as provided by health agencies. Do not cut sheets, always use their full size and fill one sheet before going on to a new one. Compile the roaster for one full calender month in advance. Fill the headings : name of the department, month, dates, and days of the weeks. Rule lines in red to divide into complete weeks. GUIDE TO COMPILING DUTY ROASTER

49. Write full name and designation of each staff member in the left hand column. Ensure that the names of all staff including those on leave and new members, are recorded accurately. When staff leaves the department through transfer or resignation, draw two lines in red, indicating the new department, or resignation or end of contract. Enter leave by ruling the line between the agreed dates. eg :- 30 days AL+ 45 days ML Use accepted symbols only. CONTI….

50. Before starting, check request book for any special request. All shifts M ( morning ), A (afternoon), N (night) should be written in top right corner. eg :- PH6, etc Asterisk (*) the name of staff nurse in charge of each shift. Count number on each shift according to grade, total and record on the roaster. GUIDE TO COMPILING DUTY ROASTER

51. Duty roaster should be submitted to the NS for checking and approval 1 week before it comes into the force. Staff who resign at any time during the year are only entitled to the number of PHs occuring upto the date of the resignation. Copy of the completed roaster, checked and signed by the ward incharge and nursing administration not later than the 26 th / 27 th days of each months. CONTI…..