Version 1.1 (October 2018)

Health Care Monitoring

System

Nurse Staffing Module

How to Guide

How do I measure patients’ levels of acuity?

The ward sister/charge nurse is responsible for ensuring that the social, psychological,

spiritual and physical care needs are assessed and classified using the Welsh Levels of

Care descriptors.

The Welsh Levels of Care consists of 5 levels of acuity ranging from Level 1 where the

patient’s condition is stable and predictable requiring routine nursing care, to Level 5

where the patient is highly unstable and at risk requiring an intense level of continuous

nursing care on a 1:1 basis.

How do I use the Welsh Levels of Care?

Please refer to the Welsh levels of Care document on how to assign the right level of care

to the patients available on the following link:

http://www.1000livesplus.wales.nhs.uk/sitesplus/documents/1011/Published%20Welsh%2

0Levels%20of%20Care%20%20edition%201.%20English%20version..pdf

How do I collect the data?

The data is required to be collected directly onto the Health Care Monitoring System

(HCMS), which is the All Wales repository for the collection of this data. The following

explains how to do this.

Accessing the Nurse Staffing Module on the Health & Care Monitoring System

(HCMS)

The information can be collected using a personal computer (PC) or via a mobile tablet

device.

Step 1: Access the Health & Care Monitoring

System log in page (see Figure 1). If the

system is unavailable or due to operational

pressures the acuity audit scores cannot be

entered directly onto the HCMS at the time of the

assessment, then there is a data collection form

that can be used to gather the data in exceptional

circumstances (Appendix 1). Any data collection

sheets must be retained for one year (refer to

your HB retention and destruction of records

Figure 1: HCMS login screen Tablet

device view

policy for further information).

Step 2; Select the Nurse Staffing module

(see Figure 2).

The acuity assessment is assessed by

selecting the Nurse Staffing option from the

menu.

Figure 2: HCMS module selection screen

Entering a new assessment on the Nurse Staffing Module on the Health & Care

Monitoring System (HCMS)

It is very important that the information entered is accurate and quality control is the key to

successful data collection.

The registered nurse undertaking the assessment is responsible for entering the data onto

the Nurse Staffing Module of the HCMS. The assessment will be undertaken on a daily

basis.

All registered nurses undertaking the assessment should be experienced in making

decisions around a patient’s acuity and be able to complete, to a consistent level, the daily

acuity assessments required. The ward manager needs to ensure that all the staff share a

general consensus on which patients would fall into each level.

What must I remember when participating in the acuity audit?

The following simple steps will ensure a consistent approach across participating wards:

The data collection will take place, at minimum, twice per year: 1st - 31st January

and 1st – 30th June (however, some HBs have decided undertake the acuity audit

on a more regular basis).

Data must be recorded on every patient, 7 days a week, for the full calendar month

for the period of the acuity audit. It is essential that data is captured every day of the

audit period to ensure that there is accurate information on which to base the

decisions on what the nurse staffing level needs to be for that ward;

Level of care scores should reflect the acuity of each patient in each bed at

1500hrs;

A numeric value needs to be entered into every box. If there is no patient in the bed

then the number zero needs to be entered into the box otherwise it will show up as

no data;

Comments are important to provide a rationale for some of the decisions being

made at ward level and it is recommended that at minimum comments are entered

for all level 4 and level 5 patients, however, all comments entered will help to inform

the patient acuity on the ward;

Any acuity data completed in the nurse staffing module but not validated by the

ward manager will be flagged as part of the monthly sign off process; and

The ward manager will need to validate the data before completing the sign off

process.

The audit is comprised of three sets of information:

Ward activity

As part of the data collection process in the HCMS, Ward activity data should be collected

for the previous 24-hour period from the start of the early shift the day before to the end

of the night shift on the morning of the acuity assessment. Ward staff will be prompted to

input a daily total of the number of ward attenders and the number of escorts on and off

site during the 24 hour period from the start of the early shift for the previous day until the

end of the night shift on the morning of the acuity assessment (figure 3)

In addition, patient flow data is collected to provide a fuller picture of activity within the

ward. Details of admissions, discharges, transfers and deaths will be gathered from the

organisation’s Patient Administration System (PAS) and entered in accordance with your

HB processes.

Figure 3: HCMS screen for the capture of ward attenders and escorts on and off the

ward.

Staffing deployed

The total number of actual staffing hours needs to be collected each day for the 24 hour

period commencing the start of the early shift the day prior to the assessment and up until

the end of the night shift on the day of the acuity assessment. Actual nursing staff refers

to the staff on duty during this 24 hour period. This data is collected by the registered

nurse undertaking the assessment and should be entered onto the HCMS for the

previous 24 hours (Figure 4). The total number of staffing hours worked during the 24

hour period under assessment is broken down as follows:

Core registered nursing staff hours – i.e. registered nurses who are on the ward establishment and working their core hours;

Core healthcare support worker hours – i.e. healthcare support workers who are on the ward establishment and working their core hours;

Registered nursing supplementary hours worked by core staff in addition to their core hours;

Healthcare support worker supplementary hours worked by core staff in

addition to their core hours;

Registered nursing bank hours worked;

Healthcare support worker bank hours worked;

Registered nursing agency hours worked; and

Healthcare support worker agency hours worked.

Figure 4: HCMS screen for the capture of staffing hours information.

Patient acuity

For each patient occupying a bed on the ward, an assessment is made of the level of care

they require as at 15:00 hrs (or for paediatrics, as agreed within your HB); some areas are

required to undertake the acuity audit more than once a day. Each patient is assigned a

level of 1, 2, 3, 4 or 5 based on the Welsh Levels of Care. This data, where possible,

should be entered directly onto the HCMS at the time of the audit by the registered nurse

undertaking the acuity assessment (Figure 5).

All registered nurses should be experienced in making decisions around a patient’s acuity

and be able to complete, to a consistent level, the daily acuity assessments required. The

ward manager needs to ensure that all the staff share a general consensus on the tyoe of

patients that would fall into each level.

The registered nurse undertaking the assessment is responsible for entering the data onto

the Nurse Staffing Module of the HCMS. The assessment will be undertaken on a daily

basis. Where possible, acuity assessments should be entered directly into the HCMS at

the time of the assessment. In exceptional circumstances, paper assessment forms can be

used but these need to be inputted onto the HCMS, at a minimum, on a weekly basis.

Data collection sheets must be retained for one year (refer to your HB retention and

destruction of records policy for further information).

The levels are colour coded in accordance with the Welsh Levels of Care. Comments are

important to provide a rationale for some of the decisions being made at ward level and it

is recommended that, at minimum, comments are entered for all level 4 and level 5

patients. However, all comments entered will help to inform the patient acuity on the ward.

Ensure all the data fields are completed with a numeric value and the information is

accurate (If there is no patient in the bed then the number zero needs to be entered into

the box)

It is very important that the information entered is accurate and quality control is the

key to successful data collection.

Figure 5: HCMS acuity assessment screen.

Staffing Decisions screen

For each day the staffing decision screen needs to be completed. The first question which

appears will be “Was the number/skill mix of nursing staff on duty during last 12/24 hours

as per the planned roster? The planned roster is the agreed nurse staffing level agreed by

the Designated Person for the Health Board/Trust (usually the Director of Nursing). If the

planned roster is RN x 3 and HCSW x 3 then any deviation from this means that the

answer to this question is 'NO' e.g. 4 RN and 2 HCSW, 2 RN and 4 HCSW 3 RN and 4

HCSW (figure 6).

Figure 6: HCMS acuity staffing decisions screen

If the response is ‘YES’ to this question then you click ‘next’ (figure 7) and move on to save

and complete the assessment

Figure 7: HCMS acuity staffing decisions screen

If the response is ‘NO’ then the question “Was it an active decision to vary the planned

roster, which was appropriate to enable to needs of the patients to be met?” will appear

(Figure 8)

Figure 8: HCMS acuity staffing decisions screen

If the response is ‘YES’ then two additional questions appear (figure 9). Please complete

and then select ‘next’ and move on to save and complete assessment. Please note any

additional comment in the comments boxes.

Figure 9: HCMS acuity staffing decisions screen

If the response is ‘NO’ then two different additional questions appear (Figure 10). For the

first question tick all that apply from the pre-populated list and enter any additional

information in the comments box.

Then complete the second question regarding incident occurrence /recording and then

select ‘next’ and move on to save and complete assessment.

Figure 10: HCMS acuity staffing decisions screen

Please note that the questions marked with an asterisks MUST be completed before you

select ‘next’. If the ‘next’ box is selected before all the questions marked with an asterisk

are complete then the below message will appear (Figure 11).

Figure 11: HCMS acuity staffing decisions screen

Save and Complete Assessment

As the Registered Nurse completing the assessment you will be asked to save the

assessment (Figure 12).

Once the assessment has been saved, the ward manager is required to validate the data

and complete the assessment. The data will then be imported into the Staff & Resources

module of the HCMS.

Figure 12: Save and Complete Screen:

Validation & Sign Off

It is very important that the information entered is accurate and quality control is the

key to successful data collection (see Appendix 2 for the biannual acuity validation

checklist).

The Ward Manager and Senior Nurse/equivalent should review and validate the acuity

assessments on a weekly basis.

The ward manager and senior nurse are responsible for regularly reviewing and validating

the acuity assessments during the month and then for signing off the complete data for the

whole month by the tenth working day of the following month.

Any acuity data completed in the nurse staffing module but not validated by the ward

manager will be flagged as part of the monthly sign off process. The ward manager will

need to validate the data before completing the sign off process.

Ward Managers and Senior/Lead Nurses should ensure that further discussion of the

results takes place at the earliest opportunity following validation/sign off.

Ward Management Module

The information in the Ward Management module needs to be updated as and when there

are changes on the ward e.g. change in specialty, number of beds, funded establishment,

planned roster. To access the ward management module click on your ward name on the

overview page and the screen in Figure 13 appears. Ward Managers need to ensure that

this information is kept up to date and reflects what has been agreed with the ‘Designated

Person’. Click update to complete.

Ward Specialty: Enter the ward specialty - at minimum select general medical or general

surgery.

Number of Beds: Enter the number of beds in use. For some wards this might vary from

day to day.

Planned Roster: Enter the planned roster for the ward per day of the week. At minimum

the number of hours for the 24 hour period must be entered although this can be broken

down by hours on an early, late and night duty, if required.

If the nurse staffing module information is being captured once a day then the total hours

for the 24 hour period must be entered in the early shift boxes and the remaining boxes left

blank. The additional boxes have been added for those wards capturing the nurse staffing

level module information more than once a day e.g. paediatric wards.

If the nurse staffing module information is being captured twice a day then the planned

roster for the daytime period can be entered under the ‘early’ and the planned roster for

the night time period can be entered under the ‘night’ box. Where a single, ‘long day’ shift

is being worked then these hours would be included under the early shift.

If the nurse staffing level information is being captured three times a day then the planned

roster for each shift would need to be entered.

Figure 13: Ward Management Screenshot.

Appendix 1: Acuity data collection form All Wales Nurse Staffing Programme:

Acuity Audit Data Collection Form

Bed 1 2 3 4 5 Ward Name

1

2

3 Site Name

4

5

6 Audit Date & Time

DD MM YY HR 7

8

9 Ward Activity: provide total number of instances for the 24 hours period from the start of the Day Shift the day before to the end of the Night Shift on the day of the acuity assessment:

10

11

12 Ward Attenders

13

14 Escorts on Site

15

16 Escorts off Site

17 Actual Staffing Hours: Provide the total number of hours for the 24 hour period from the start of the Day Shift the day before to the end of the Night Shift on the day of the acuity assessment:

18

19

20 RN HCSW

21 Core Staff

22 RN HCSW

23 Bank

24 RN HCSW

25 Agency

26 RN HCSW

27 Supplementary

28 NB. Supplementary figures should include any additional hours worked on your ward by core staff, beyond their established hours and/or any clinical hours worked by the Ward Sister . Do not record this extra time in the core staff category. The figures should also include staff that are borrowed from other areas.

29

30

Comments Completed By

Signature

Version 2.1 (June 2019)

Appendix 2: Bi annual audit validation checklist

Action

1 During January/June complete the ward management module on HCMS with the

required information

2 Complete the assessment for every day during the month of January/June .

3 Ensure the following data is entered correctly on the nurse staffing module of the HCMS

on a weekly basis:

Enter the date and time of the assessment

Acuity data: use the Welsh Levels of Care to measure the acuity and dependency

of each patient occupying a bed at 3pm.

Provide rationale for the acuity of patients, particularly for level 4 and 5 patients.

Enter the total number of ward attenders/escorts off site for the 24 hour period from the start of the day shft the day before to the end of the night shift on the day of the assessments eg: 7am-7pm.

Enter the number in hours the actual number of core and supplementary staff deployed from 7am the day before to 7am on the morning of the assessment.

(Note: supplementary staff includes any hours worked by core staff above their contacted hours (eg: staff working additional hours or full time staff working overtime), staff from other areas and staff working bank and agency shifts.

4 Ensure all the data fields are completed with a numeric value and the information is

accurate.

5 Ward Managers and Senior Nurses to review and validate the acuity assessments on a

weekly basis during the month.

6. Ward activity data is uploaded as per Health board process

7. Senior Nurse or equivalent as identified by the health board to validate and sign off the

assessment as being complete and accurate by the 10th working day of the following

month

8. Provided that the data is accurate, PHW to return visualizer reports by 20th working day

of the following month

9. Ward Managers, Senior Nurses and Lead nurses should ensure that further discussion

of the results takes place at the earliest opportunity following validation/sign off.