Seven years in the making, Virginia-based Sentara Health has deployed its Patient Acuity Nursing Tool (PANT) across all 12 hospitals in the Sentara Health system, encompassing more than 100 inpatient nursing units. A poster detailing the tool, “Using a Patient Acuity Nursing Tool to More Equitably Distribute Nursing Workload,” was a top 10 scoring poster at the 2023 AMSN Annual Convention. The tool, an automated rules-based algorithm built into the electronic health record (EHR), calculates how long it takes the direct patient care team to provide safe, quality care. Based on nursing documentation and physician orders, PANT helps charge nurses make informed decisions regarding patient assignments and resource allocations based on a comprehensive measure of patient acuity and nursing workload.
According to Kelsey Jones, BSN, RN, MEDSURG-BC, magnet coordinator at Sentara Leigh Hospital and PANT project coordinator, “This tool originated when two medical-surgical nurses identified that we lacked an evidence-based, objective method to determine patient workload and inform nurse assignments. Although the charge nurse aims to be ‘fair’ when making assignments and considers multiple factors, such as room location, isolation, and nurse skillset, this is a subjective method.” She says, “PANT is an objective workload score that was developed by nurses, for nurses. Clinical team members have been involved in every step of the development, implementation, and validation of PANT. Clinical nurse involvement was essential when identifying nursing workload elements and determining the appropriate amount of time associated with that item.”
Jones says 150 medical-surgical workload elements served as the foundation of the tool. In subsequent years, additional nursing workload elements were implemented to better reflect nursing care and observe the differences between nursing units. The process was iterative and involved identifying the workload element, the time associated with each item, and where it was documented in the EHR. This process was refined, and PANT now contains over 280 workload elements reflecting medical-surgical, stroke, oncology, progressive or intermediate care, and critical care patient populations.
Jones continues, “We quickly realized the clinical teams needed a way to functionally use the PANT score, in a meaningful way. The EHR had limited capabilities, which has improved over the years. We needed a way for the clinicians to view the PANT score when they created patient assignments, so we created a patient list column, a report screen that displays elements that are driving the PANT score, and the EHRs Assignment Wizard application.”
Overall, Jones says the tool has been well received, with the PANT team able to explain how the scores are calculated, what the numbers mean, and confirm and investigate whether the PANT score reflects the patient care nurses are providing. A significant amount of time has been spent on staff education, with a site lead assigned at each of Sentara’s 12 hospitals. Educational flyers and a computer-based training module were provided, and PANT has been incorporated into nursing educational sessions and competency tools for specific nurse roles, such as preceptor, charge nurse, and manager. “This has helped reinforce the importance of the tool from our clinical teams up through the leadership teams,” Jones says. “It also allows us to target new employees as we experience turnover.”
The learning curve has been overcome by relying on the same nursing foundations used in clinical practice, Jones explains. This means assessing the issues before diagnosing the root cause or problem that needs to be solved, consulting best practices, involving clinical teams comprised of various experts in different fields and all levels of expertise, and obtaining support from executive leadership. Further, she says, “We’ve updated the EHR algorithm many times along the way. With each update, we perform an extensive validation process that includes both retrospective workload analysis and chart audits. Through this process, we have identified fixes to our build.”
Jones stresses that PANT does not require additional documentation or additional work from the clinician to calculate a patient’s PANT score, nor does it dictate or replace clinical judgment. “It is simply an extra tool in our tool belt to be used when creating patient assignments (objective PANT score) in combination with clinical judgment (staff skill mix, room location, patient-specific needs). Equitable assignments help our team members build resilience and support one another,” she says. “PANT also has helped our hospital system better understand the depths of nursing documentation requirements. Furthermore, PANT has informed conversations at the executive level related to census-based staffing grids and the cost of nursing care.”
Jones says PANT is off to a great start, and the team is in the early stages of sharing the tool on an external platform. She anticipates ongoing work with the process improvement team to incorporate nursing workload into the nursing grid assignment and the decision process.
The PANT development team received positive feedback at the 2023 AMSN Annual Convention. According to Jones, “The overwhelming response from nurses across the country was that it’s right on track with what nurses want! Nurses want the ability to use acuity/workload tools to help guide their assignment process and the ability to inform conversations around resources. Nurses want to be involved in these conversations.”
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Kelsey Jones, BSN, RN, MEDSURG-BC, is an experienced nurse who has established a strong foundation of clinical expertise in medical-surgical nursing, serving over 10 years as a direct-care clinician before transitioning to her current position, magnet coordinator at Sentara Leigh Hospital. In her current role, Kelsey has broad influence over process improvement, quality, structural empowerment, and nursing excellence. She has spent the last five years serving as the team’s nurse project coordinator, responsible for the development, validation, and implementation of PANT, a nursing workload decision tool. In March-April 2023, the team published an article in MEDSURG Nursing Journal, detailing the impact of this workload-decision tool on census-based staffing grids within the medical-surgical healthcare setting. In her personal life, Kelsey serves on a local community board for early childhood education and participates in community outreach activities to provide health education for a local elementary school.