Patient Classification system and staff scheduling

CREATED AND PRESENTED BY.
DODIYA RIDDHI NILESH
ROLL NO. 03

 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

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

 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

 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……

 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 ACCORDINGTO
THE NUMBER OF HOURS ALLOTED

 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……

 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…..

Patient Classification system and staff scheduling

 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

 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…….

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

 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

 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….

 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

 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……

 CATEGORY = 1
 CATEGORY = 2
 CATEGORY = 3
 CATEGORY = 4
 CATEGORY = 5
CATEGORIES

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

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

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

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

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

 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

 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……

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

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

 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

 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……

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

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……

PRINCIPLES OF PLANNING DUTY
ROASTER
 Coverage
 Continuity
 Flexibility
 Stability
 Cost effectiveness

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

 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

 The nurse works for 12h for seven shifts in 2
weeks, has 3 days work and 4 days off in the 1st
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

 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

 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

 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

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

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

 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.
CROSSTRAINING

 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

 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

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

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

 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

 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 PLANNINGTHE DUTY
ROSTER

 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

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.
GUIDETO COMPILING DUTY
ROASTER

 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….

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.
GUIDETO COMPILING DUTY
ROASTER

 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 26th/ 27th
days of each months.
CONTI…..

Patient Classification system and staff scheduling

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Patient Classification system and staff scheduling