Read NHPPDGuidelinesSeptember2003.pdf text version

GUIDELINES FOR THE IMPLEMENTATION OF NURSING HOURS PER PATIENT BED DAY (NHPPD) MODEL

Within the DEPARTMENT OF HEALTH AND HUMAN SERVICES, TASMANIA

This paper has been prepared by the Department of Health and Human Services Tasmania Australian Nursing Federation Health and Community Services Union

GUIDELINES SEPTEMBER 2003

1

INTRODUCTION

Following the agreement by the Department of Health and Human Services, the Australian Nursing Federation and the Health and Community Services Union to a Consent Order in the Australian Industrial Relations Commission the parties have met to progress implementation of the NHPPD model. There is now a legal requirement to give effect to this order and meet the benchmarked hours. The Government has allocated appropriate funding to enable employment of agreed nursing hours. All parties recognise the importance of consultation with the nursing workforce and are committed to engaging nurses in Tasmania in the process of implementing and monitoring the NHPPD model. The NHPPD model is a systematic nursing workload monitoring and measuring system and is not designed to be used as a rigid mandatory determinant of staffing. This is because actual staffing arrangements must reflect ward specific criterion and clinical assessments. The model has seven categories and associated numbers of nursing hours per patient day (Appendix 1). The nursing hours include EN, RN1 and RN2 hours. Tables demonstrating the outcome of the application of the guiding principles of the NHPPD model to the Royal Hobart Hospital, the Launceston General Hospital and the North West Regional Hospital are included as Appendix 2 . This paper has been developed to assist nursing staff at unit level to understand the effect of the nursing hours per patient day model on their ward/unit and will continue as part of an ongoing process of reviews of ward categories and model monitoring.

GUIDELINES SEPTEMBER 2003

2

THE NHPPD MODEL SHOULD BE MADE VISIBLE AT THE WARD OR UNIT LEVEL Each hospital site is responsible for ensuring that the NHPPD model is made visible at ward or unit level via an appropriate mechanism. The application of the model should be clearly understood by nurses at the ward or unit level.

HOW CAN THE NHPPD MODEL BE MADE VISIBLE?

Listed below are 4 processes that will assist you to understand the application of the NHPPD model to your Ward or Unit. Your Clinical Nurse Manager will be available to assist nursing staff in understanding the following processes:

PROCESS 1: WARD PROFILE: It is important to first understand the ward profile, that is the number and type of patients by diagnosis that are admitted to the ward. The Nurse Manager on each ward has access a range of information including DRGs for their ward. The next step is to consider the turnover of patients within the ward. The model suggests the addition of admissions plus discharges plus transfers divided by bed number. Admission and discharge information is available through the Director of Nursing/Nurse Co Director. Average turnover is: Total Number of patients /Total Occupied Bed Days X 100 Once turnover has been calculated it is then possible to determine which categories are applicable to the unit up to a maximum of 3 categories (see page 3). This will enable the determination of the NHPPD suitable to the ward/unit. It is important to remember that if the nature of the ward changes in relation to any of the major criteria then the categorisations may be reviewed and the NHPPD adjusted accordingly.

PROCESS 2: NURSING HOURS Once the ward profile and NHPPD is determined the following formula is used. Bed Occupancy x Number of Hours for the Ward or Unit x Days of the Week the service operates.

GUIDELINES SEPTEMBER 2003

3

Example 1 (single category identified) A category A ward with 20 beds, has an average occupancy of 100% the formula is as follows: 20 (Bed Occupancy at 100%) x 7.5 (NHPPD value for a Category A ward) x 7 (days per week)= 1050 Nursing Hours per week. This allows the determination of where those nursing hours should be allocated across the roster. The hours could be spread across the week in shifts as follows: SUN AM PM ND TOTAL: 7x8 6x8 3 x 10 134 MON 7x8 6x8 3 x 10 134 TUES 7x8 6x8 3 x 10 134 WED 7x8 6x8 3 x 10 134 THUR 7x8 6x8 3 x 10 134 FRI 7x8 6x8 3 x 10 134 SAT 7x8 6x8 3 x 10 134

The table shows that on each day you can have a rostered number of seven nurses on an AM shift, 6 nurses on a PM shift, and three nurses on night duty, with this allocation of hours. In a simplistic calculation like this, the total number of hours utilised over a one week period adds up to 938. However, given the Nursing Hours per Patient Bed Day calculation allows for a total number of hours over the week of 1050, there are 112 hours left over. Next we turn to how these hours could be allocated. You may have a particular surgeon who always lists patients on a Thursday, meaning that every Thursday there is higher patient activity. So the ward or unit may decide to add an extra two 8 hour shifts on a Thursday afternoon, and another one nurse for the night shift. This would use up to 26 hours. You may decide that the mornings are generally busier and an additional nurse is required every day, changing the profile to 8 nurses each AM shift. Example 2 (multiple categories identified) 20 bed unit (Bed Occupancy at 100%) with 3 categories, 4 beds A, 10 beds B, 6 beds C 4 x Category A @ 7.5 (NHPPD) x 7 = 210 Nursing Hours per week. 10x Category [email protected] 6.0 (NHPPD) x 7 = 420 Nursing Hours per week. 6 x Category [email protected] 5.75 (NHPPD) x 7 = 241.5 Nursing Hours per week. TOTAL HOURS: = 871.5 hours available to be rostered to suit the ward needs using the process detailed above.

GUIDELINES SEPTEMBER 2003

4

PROCESS 3: NURSING ESTABLISHMENT Under this mechanism, the calculation for nursing hours is as follows: Using the first example, a Category A, 20 bed ward with 100% occupancy. 20 (Bed Occupancy at 100%) x 7.5 (NHPPD for a Category A ward) x 7 = 1050. 1050/38 (Hours for one FTE) = 27.6 FTE This means that the Ward or Unit should have an FTE profile of 27.6 full time equivalent (38 hours) nurses who provide direct patient care. The profile however needs to be adjusted to include a relief factor for Day Workers of 8 weeks and for Shift Workers 10 weeks. For example in a ward where it has been determined that 27.6 full time equivalent shift working nurses are required you would calculate the leave relief factor by multiplying 27.6 FTE by 52 and dividing the result by 42. This would result in a` requirement of 34.17 full time equivalent shift working nurses.

PROCESS 4: COMPUTERISED SYSTEM ­ NURSING HOURS AND ESTABLISHMENT Utilising the ward profile data, category(s) for NHPPD staff may wish to utilise the Computerised Staffing Calculator. This computerised system will calculate roster requirements as explained in Process 2 and 3 utilising the data determined by the ward/unit. This computerised roster system is available from the Directors of Nursing within the three major hospitals and may assist in the application of the NHPPD model to roster design.

FLEXIBILITY OF THE MODEL

Nurses need to be aware that the nursing hours per patient bed day model may be subject to ongoing development and refinement, this will occur in full consultation with all parties. Consideration must be given to the following key principles: · · · · · Clinical assessment of patient needs; The demands of the environment such as ward layout; Statutory obligations including workplace health and safety legislation; The requirements of nurse regulatory legislation and professional standards; and Reasonable workloads.

GUIDELINES SEPTEMBER 2003

5

WORKLOAD MONITORING COMMITTEE

1. A Workload Monitoring Committee (WMC) will be established at the Royal Hobart Hospital, the Launceston General Hospital and the North West Regional Hospital. 2. The WMC is to consist of equal union and employer representation with a maximum of eight members. 3. The WMC has an advisory role in reviewing, assessing and making recommendations to the Chief Executive Officer of the Hospital on an as needs basis, regarding those wards or other clinical units where nursing services are provided and NHPPD assessments have been completed and agreed. Factors to be considered are: · · · Nursing workloads generally (including outpatient clinics attached to inpatient wards) Admissions, discharges and patient movements generally, including transfers; Bed usage and management generally.

4. The WMC's shall be provided with ward profile, statistical, DRG, and other relevant information on a regular basis. 5. The consultative procedures in relation to the NHPPD shall operate as far as practicable without formality with a view to reaching a consensus about matters to be considered. 6. Any unresolved issues arising out of the WMC shall be dealt with under the Grievance Procedure and shall commence at the beginning of Step 2 of those procedures. 7. The Agency NHPPD Model Implementation Officer shall be involved in Workload Monitoring Committees as required to provide a statewide consistency to the implementation process.

REVIEW PROCESS At the conclusion of twelve months from the date of agreement being notified to the Australian Industrial Relations Commission on the NHPPD model, the Department will undertake a review of the model's functional effectiveness and the implementation methodology. In undertaking the review, the Department will consult with CNM's, DON's and ANF and HACSU. The review will provide a report to the Secretary of DHHS. The review will consider ward profile, statistical, DRG, comparative and other relevant information.

GUIDELINES SEPTEMBER 2003

6

The WMC's, as well as ANF and HACSU, will be provided a copy of the report. Any grievance or dispute arising from the review report shall be dealt with in accordance with the Workload Grievance Procedure. GRIEVANCE PROCEDURE Any grievance or dispute relating to nursing workloads will be resolved by following the steps set out below. Any nurse or management representative and parties to the Enterprise Agreement may raise a grievance or dispute under this procedure. If at any time in the consideration of the grievance or dispute, it appears that the proposed resolution has budget implications, the proposed resolution is to be forwarded to the Director, Hospital and Ambulance Services who will action it within the procedures required by Government. Work shall continue in accordance with the status quo while any grievance or dispute is being dealt with under this procedure unless interim arrangements are agreed by the parties which shall be implemented immediately. Step 1 ­ Ward/Unit Level If a grievance or dispute arises regarding a NHPPD issue it must first be raised by the individual nurse or group of nurses at ward/unit level with the Level 3 Nurse Manager for resolution. The Nurse Manager may consult the Director of Nursing to assist in the resolution. This step shall be concluded within one calendar week from the time it was raised by the nurse or group of nurses with the relevant Nurse Manager. Step 2 ­ Hospital Level If a grievance or dispute cannot be resolved at Step 1, the matter is to be referred in writing to the Director of Nursing who will convene a Specialist Panel. The specialist panel will include one each ANF and HACSU nominee and two management nominees (approved by the CEO). Recommendations from the specialist review panel shall be achieved by consensus. If consensus cannot be reached the grievance or dispute remains unresolved. The Specialist Panel shall make recommendations to the Chief Executive Officer for the resolution of the grievance or dispute. If the CEO does not accept the recommendations he/she shall advise the Specialist Panel of the reasons. This step shall be concluded within one calendar week from the time it was referred to the Director of Nursing.

GUIDELINES SEPTEMBER 2003

7

Step 3 ­ Agency Level If the grievance remains unresolved at the conclusion of Step 2 the CEO shall refer the matter in writing for negotiation between the Deputy Director Corporate Services, Human Resource Services and ANF and HACSU representatives in an attempt to resolve the grievance or dispute. This step shall be concluded within one calendar week from the time it was referred to the Deputy Director Corporate Services, Human Resource Services unless a longer period is agreed between the parties. Step 4 If the grievance or dispute cannot be resolved at Step 3, either party may refer the matter to the Australian Industrial Relations Commission for its assistance which shall include conciliation and if necessary, arbitration. The grounds for a grievance shall include but not be limited to: · · · Unreasonable or excessive patient care or nursing duties is required of a nurse other than occasionally and infrequently; To perform nursing duty to a professional standard, a nurse is effectively obliged to work unpaid overtime on a regularly recurring basis; A reasonable complaint to the appropriate hospital authority about capacity to observe professional mandatory patient care standards has not been responded to or acted upon within a reasonable time; or A particular nurse or group of nurses is being consistently placed under an unreasonable or unfair burden or lack of adequate professional guidance because or the workload or the staffing skill mix of the team. The workload requirement effectively denies any reasonable access to professional development.

·

·

FURTHER INFORMATION:

Should you require further explanation regarding these processes contact the Director of Nursing/Nurse Co-Director in your Hospital.

GUIDELINES SEPTEMBER 2003

8

APPENDIX 1

NHPPD GUIDING PRINCIPLES

BED CATEGORY A NHPPD

(OVER 24HRS)

CRITERIA FOR MEASURING DIVERSITY, COMPLEXITY AND NURSING TASKS REQUIRED · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · High Complexity High Dependency Unit @ 6 beds within a ward Tertiary Step Down ICU High Intervention Level Specialist Unit/Ward Tertiary Level 1:2 staffing Tertiary Paediatrics High Complexity No High Dependency Unit Tertiary Step Down CCU/ICU Moderate/High Intervention Level Special Unit/Ward including extended secure Mental Health Unit High Patient Turnover (1) > 50% FHHS Paediatrics (2) Secondary Paediatrics Tertiary Maternity High Complexity Acute Care Unit/Ward Moderate Patient Turnover > 35%, OR Emergency Patient Admissions > 50% Psychogeriatric Mental Health Moderate Complexity Acute Rehabilitation Secondary Level Acute Unit/Ward Emergency Patients Admissions > 40% OR Moderate Patient Turnover > 35% Secondary Maternity Moderate Complexity Moderate Patient Turnover > 35% Sub Acute Unit/Ward Rural Paediatrics Moderate/Low Complexity Low Patient Turnover < 35% Care Awaiting Placement/Age Care Sub Acute Unit/Ward Ambulatory Care including: Day Surgery Unit and Renal Dialysis Unit

7.5

B

6.0

C

5.75

D

5.0

E

4.5

F

4.0

G

3.0

(1) (2)

Turnover = Admissions + Transfers + Discharges divided by Bed Number FHHS Paediatrics additional formulae: Birth; Neonates; ED; OR.

GUIDELINES SEPTEMBER 2003

9

APPENDIX 2 ROYAL HOBART HOSPITAL

Ward Beds DA % Occ Actual FTE Review FTE Review NHPPD Category

Med 1B North Med 1B South Med 2B North Med 2B South Med DCCM Med DPM (Psych Ward) Med DWYER Med PICU Sur 2DC Sur 2DS Sur CTU Sur General Sur NSU Sur Ortho Surg SU WACS Gynae WACS NNICU WACS PAEDS Maternity& Birthing Unit Emergency Department

30 20 30 30 14 34 23 8 20 17 4 26 20 25 18 10 16 24 30

29.60 19.46 29.60 29.60

99% 97% 99% 99%

30.94 22.80 32.20 30.55

37.15 28.09 37.22 37.22

5.34 A3%B7%C40%D33%F17

%

6.06 A20%B40%C20%D20% 5.34 A7%B7%C20%D33%F33

%

5.34 B7%C43%D33%F17%

No B M Mental H

22.43 16.90 12.30 22.90 16.60 22.80 15.80 8.90 19.88 23.30

98% 85% 72% 88% 83% 91% 88% 89% 83% 78%

22.93 19.68 19.28 28.73 30.76 26.90 23.66 14.92 41.40 59.41

27.44 24.29 20.12 32.50 30.76 32.04 23.47 14.92 37.74 61.22

5.13 C17%D83%

Mental H

6.00 B 100% 6.77 A 50%B 50%

No B M

6.00 B 100% 7.31 A 50% B 50% 5.94 B 75% C 25% 6.00 B 100% 6.30 A 20%B 80%

No B M

7.46 A 42% B 58% 8.86 A27%B40% D33%

WARD TOTAL

THESE FIGURES INCLUDE THE CLINICAL NURSE MANAGERS

404.16

444.84

GUIDELINES SEPTEMBER 2003 10

Ward

Beds

DA

LAUNCESTON GENERAL HOSPITAL % Occ Actual Review Review FTE FTE HPPD

91% 94% 93% 96% 87% 86% 51% 54%

Category

Medical 5D Medical 3G Medical 4D Medical 6D Surgical 5A Surgical 5B Paed 4K Obstetric 4O/4B ICU SCN 4N

32 16 32 32 32 28 32 30 11 9

29 15.08 29.6 30.8 27.9 24.1 16.3 16.3

30.42 20.07 31.98 33.03 34.33 31.72 28.08 50.37

39.20 20.92 35.03 36.41 40.54 34.71 28.08 46.56

5.75 5.75 5.01 5.02 6.19 6.10 6.98 6.98

A6%B9%C69%D16% D 100% C19%D56%E25% C19%D56%E25% A19%B44%C37% A14%B43%C43%

No B M

A25%C75% + Del

No B M No B M

WARD TOTAL

260.00

281.46

THESE FIGURES INCLUDE THE CLINICAL NURSE MANAGERS

GUIDELINES SEPTEMBER 2003 11

NORTH WEST REGIONAL HOSPITAL

Ward Medical Open Surgical West Surgical / Rehab Paed ICU /CCU Beds D A % Occ

34 22 26 14 8 26.9 15.3 19.7 4.6 79% 70% 76% 33%

Actual FTE

33.61 21.69 31.73 11.852

Review FTE

37.02 21.64 27.67 11.85

Review NHPPD

Comments

5.84 B40%C60% 5.85 B20%C80% 5.90 A4%B32%C64% 11.30 B50%C50% (Needs 2/2/2)

No B M

WARD TOTAL

98.88

98.19

Note: Benchmark is not possible in Paediatrics because it requires 2/2/2 cover

THESE FIGURES INCLUDE THE CLINICAL NURSE MANAGERS

GUIDELINES SEPTEMBER 2003 12

Information

DRAFT

12 pages

Report File (DMCA)

Our content is added by our users. We aim to remove reported files within 1 working day. Please use this link to notify us:

Report this file as copyright or inappropriate

418064


You might also be interested in

BETA
DRAFT
UTS Final Report
Microsoft Word - Safe Staffing - User Manual - NHPPD - Version 1.1.doc