The charge nurse is responsible for creating daily nurse/patient assignments, which are informed by the location of the patient within a unit and the clinical judgment of the charge nurse.

主管护士负责创建日常护士/患者任务，这些任务由患者在单位内的位置和主管护士的临床判断来通知。

THE PROBLEM

问题

Assignments typically do not incorporate objective assessment of workload or patient acuity. As a result, nurses could be responsible for several high-acuity patients at the same time.

任务通常不包括对工作量或患者视力的客观评估。因此，护士可能同时负责几个高视力患者。

Nurses at Sentara Leigh Hospital were interested in a more objective approach to making nurse/patient assignments. They began evaluating nursing workload tools used in real time to guide these decisions.

Sentara Leigh医院的护士对制定护士/患者任务的更客观方法感兴趣。他们开始实时评估用于指导这些决策的护理工作量工具。

'The existing literature yielded numerous examples of nursing workload measurement tools,' said Sentara Health Patient Acuity Nursing Tool (PANT) Project Coordinator Kelsey Jones, RN. 'Each of these tools had its own strength, such as using the electronic health record, identifying key elements of patient care, and defining both direct and indirect elements of care..

“现有文献提供了许多护理工作量测量工具的例子，”Sentara Health Patient Acuity nursing Tool（PANT）项目协调员凯尔西·琼斯（KelseyJones）说。“这些工具都有自己的优势，例如使用电子健康记录，识别患者护理的关键要素，以及定义直接和间接护理要素。”。。

'However, a number of limitations precluded implementation of these tools at Sentara Leigh Hospital,' she noted. 'These limitations included redundant manual data entry, assessments based on retrospective data only, and infrequent updates to workload assessments.'

“然而，Sentara Leigh医院存在一些限制，无法实施这些工具，”她指出这些限制包括冗余的手动数据输入、仅基于回顾性数据的评估以及工作量评估的不频繁更新。”

Because patient census and requisite workload change constantly, nurse assignment models must be flexible and updated with near real-time patient information to inform a daily decision support tool. As a result, the nurses did not find an appropriate evidence-based system to identify workload and patient acuity that was driven by objective data..

由于患者普查和必要的工作量不断变化，护士分配模型必须灵活，并使用近乎实时的患者信息进行更新，以告知日常决策支持工具。因此，护士们没有找到一个合适的循证系统来识别由客观数据驱动的工作量和患者视力。。

PROPOSAL

提案

Historically, nurses lacked a reliable method to measure and manage care complexity. Charge nurses created nurse assignments based on judgment, patient daily census and the number of staff at the beginning of each shift. This inconsistently accounted for nursing workload and patient care needs.

从历史上看，护士缺乏可靠的方法来衡量和管理护理的复杂性。主管护士根据判断、患者每日普查和每班开始时的员工人数制定护士任务。这与护理工作量和患者护理需求不一致。

'In 2016, two medical-surgical clinical nurses approached the hospital's nursing research forum with a proposal to create a tool that quantified patient workload and ensured an equitable distribution of patient care needs among nursing staff,' Jones recalled. 'Project approval was obtained from the system's chief nursing officer and Nurse Executive Council..

琼斯回忆道：“2016年，两名内科外科临床护士与医院护理研究论坛接洽，提议创建一种工具，量化患者工作量，确保护理人员公平分配患者护理需求。”项目获得了该系统首席护理官和护士执行委员会的批准。。

'The CNO served as the project's executive sponsor and incorporated a nursing workload algorithm into the nursing strategic plan, with time and resources allocated for development, testing and integration within the health system.'

“CNO担任该项目的执行赞助商，并将护理工作量算法纳入护理战略计划，为卫生系统的开发、测试和整合分配了时间和资源。”

An interprofessional team created an automated, rule-based algorithm (the Patient Acuity Nursing Tool, or PANT) to capture the time required to provide safe, quality patient care in near real time. The PANT development team consisted of clinical nurses, a nurse project manager, EHR system analysts, health services researchers, biostatistician and nurse scientist..

一个跨专业团队创建了一个自动化的，基于规则的算法（患者视力护理工具或PANT），以捕捉近实时提供安全，优质患者护理所需的时间。PANT开发团队由临床护士、护士项目经理、EHR系统分析师、卫生服务研究人员、生物统计学家和护士科学家组成。。

MEETING THE CHALLENGE

迎接挑战

PANT is an internally developed algorithm unique to Sentara Health.

PANT是Sentara Health独有的内部开发算法。

'The PANT team followed quality improvement methodology to design the PANT algorithm, involving clinical staff in each stage of the development,' Jones explained. 'First, the team identified the nursing workload items based on nursing standards of care and internal competency tools.

琼斯解释说：“PANT团队遵循质量改进方法来设计PANT算法，让临床工作人员参与开发的每个阶段。”首先，该团队根据护理标准和内部能力工具确定了护理工作量项目。

'The team collaborated with nursing staff and IT team members to determine the amount of time and EHR documentation associated with each workload item,' she continued. 'The IT team members built the PANT algorithm and performed testing to confirm the algorithm operated as expected. PANT team members collaborated with clinical nurse staff to validate the patient-specific PANT score was reflective of the nursing workload being performed.'.

她继续说：“该团队与护理人员和IT团队成员合作，确定与每个工作量项目相关的时间和EHR文档。”IT团队成员构建了PANT算法并进行了测试，以确认算法按预期运行。PANT团队成员与临床护理人员合作，验证患者特定的PANT评分反映了正在进行的护理工作量。”。

Data analyst team members performed a series of descriptive analyses (basic descriptive statistics describing the distribution of the workload data, normality, missingness and outliers) to validate the functionality of the algorithm.

数据分析师团队成员进行了一系列描述性分析（描述工作量数据分布、正态性、缺失和异常值的基本描述性统计），以验证算法的功能。

'PANT has now been implemented in more than 100 inpatient units across all 12 hospitals within the Sentara system,' Jones reported. 'Development of PANT educational materials – for example, tipsheets and computer-based learning modules – and incorporation of PANT during orientation for nurse preceptor, charge and manager roles have improved awareness, knowledge and use of the algorithm..

琼斯报道说：“现在，森塔拉系统内所有12家医院的100多个住院单位都实施了PANT。”开发PANT教育材料（例如，小费表和基于计算机的学习模块），并在护士导师，主管和经理角色的定向过程中纳入PANT，提高了对算法的认识，知识和使用。。

'The PANT score is used by the charge nurse team to more equitably distribute daily patient assignments,' she continued. 'Staff continue to use their clinical judgement and intimate understanding of both patient and staff needs in combination with the objective PANT score.'

“PANT评分被护士长团队用来更公平地分配每日患者任务，”她继续说道员工继续使用他们的临床判断和对患者和员工需求的深入了解，并结合客观的PANT评分。”

Nursing leadership use the PANT score to better articulate nursing workload at the patient level and unit level. PANT data has been incorporated into multiple dashboards, enabling operational leaders to view real-time and historical or trended data.

护理领导力使用PANT评分来更好地表达患者层面和单位层面的护理工作量。PANT数据已整合到多个仪表板中，使运营领导能够查看实时、历史或趋势数据。

RESULTS

结果

Unbalanced or unevenly distributed workloads and a perception of insufficient time to complete nursing tasks can increase the risk of burnout and turnover. As the nationwide nursing shortage continues, PANT is a data-driven tool that maximizes patient and nursing outcomes, Jones said.

不平衡或分布不均的工作量以及认为完成护理任务的时间不足会增加职业倦怠和离职的风险。琼斯说，随着全国护理短缺的持续，PANT是一种数据驱动的工具，可以最大限度地提高患者和护理结果。

'The PANT tool has been extensively validated and determined to be an accurate reflection of nursing workload for medical surgical, oncology, intermediate and critical-care patient populations,' Jones reported. 'This workload score is used by clinical staff and leaders to inform decisions at the operational level..

琼斯报道说：“PANT工具已得到广泛验证，并被确定为准确反映医疗外科、肿瘤学、中级和重症监护患者群体的护理工作量。”临床工作人员和领导使用此工作量评分为操作层面的决策提供信息。。

'PANT workload scores were translated into nursing hours per patient day (NHPPD) and compared to the pre-determined NHPPD defined in staffing grids,' she continued. 'The comparison of PANT to staffing grid NHPPD informed the overall functionality of PANT. This is a unique attribute of the tool and provides clarity around nursing unit differences within the same nursing census-staffing matrix.'.

她继续说：“PANT工作量评分被转换为每天患者的护理小时数（NHPPD），并与人员配置表中定义的预先确定的NHPPD进行比较。”将PANT与人员配置网格NHPPD进行比较，了解了PANT的整体功能。这是该工具的独特属性，并在同一护理普查人员配置矩阵中明确了护理单位的差异。”。

ADVICE FOR OTHERS

给他人的建议

'Interdisciplinary collaboration is key,' Jones exclaimed. 'Establishing a team that includes all areas – IT, data analysis and clinical – brings varying perspectives to the table. Involving front-line team members in tool design and development is essential to establishing user-level buy-in, and ultimately, project success..

琼斯感叹道：“跨学科合作是关键。”建立一个包括所有领域（IT、数据分析和临床）的团队会带来不同的观点。让一线团队成员参与工具设计和开发对于建立用户级认可以及最终项目成功至关重要。。

'Also, connecting the project to the organization's strategic plan is important,' she added. 'This ensures the project receives support and organizational resources, fostering success.'

她补充说，将项目与组织的战略计划联系起来也很重要这确保了项目获得支持和组织资源，促进了成功。”

Nursing workload tools help articulate the intensity of work being performed by direct-care staff, she said.

她说，护理工作量工具有助于明确直接护理人员的工作强度。

'The ability to articulate this helps foster understanding with non-clinical teams, informing conversations related to patient needs, clinical workload and traditionally designed census-based staffing systems,' she concluded.

她总结道：“表达这一点的能力有助于促进与非临床团队的理解，为与患者需求、临床工作量和传统设计的基于人口普查的人员配置系统相关的对话提供信息。”。

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关注比尔在LinkedIn上的热门报道：比尔·西维奇

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给他发电子邮件：bsiwicki@himss.org

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医疗IT新闻是HIMSS的媒体出版物。