Chapman Helen, Kilner Margaret, Matthews Rebekah, White Abi, Thompson Angela, Fowler-Davis Sally, Farndon Lisa
Head of Integrated Community Care, Sheffield Teaching Hospitals NHS Foundation Trust.
Business Manager, Sheffield Teaching Hospitals NHS Foundation Trust.
Br J Community Nurs. 2017 Apr 2;22(4):192-196. doi: 10.12968/bjcn.2017.22.4.192.
Acuity and dependency in the community nursing caseload in combination with safe staffing levels are a national issue of concern. Current evidence suggests that there are no clear approaches to determining staff capacity and skill mix in these community settings. As community nursing caseloads are large with differing complexities, there is a need to allocate community nursing with the best skill mix to achieve the best patient outcomes. A city-wide service improvement initiative developed a tool to classify and categorise patient demand and this was linked to an electronic patient record system. The aim was to formulate an effective management response to different levels of acuity and dependency within community nursing teams and a consensus approach was used to allow the definition of complexity for twelve packages of care. The tool was piloted by a group of community nurses to assess the validity as a method to achieve a caseload classification. Seventy nurses were trained and applied the tool to 3000 patient referrals. Based on this, standards of care were agreed including expectations of assessment, intervention, visit length and frequency. Community nursing caseloads can now be organised according to acuity and complexity of patient need, which determines allocation of staff and skill mix.
社区护理工作量中的 acuity 和依赖性，再加上安全的人员配备水平，是一个全国性的关注问题。目前的证据表明，在这些社区环境中，没有明确的方法来确定人员能力和技能组合。由于社区护理工作量大且复杂性各异，需要分配技能组合最佳的社区护理人员，以实现最佳的患者治疗效果。一项全市范围的服务改进计划开发了一种工具，用于对患者需求进行分类和归类，并将其与电子病历系统相链接。目的是针对社区护理团队中不同程度的 acuity 和依赖性制定有效的管理应对措施，并采用一种共识方法来确定十二种护理套餐的复杂性定义。一组社区护士对该工具进行了试点，以评估其作为实现工作量分类方法的有效性。七十名护士接受了培训，并将该工具应用于 3000 例患者转诊。在此基础上，商定了护理标准，包括评估、干预、访视时长和频率的预期。现在可以根据患者需求的 acuity 和复杂性来安排社区护理工作量，这决定了人员分配和技能组合。
