BOOKS OF RtfiDIfGS - PAHO/WHO

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TABLE 1. PATIENT CLASSIFICATION
Ca Re Aummt : : Wmd Poes .o4rdilnO to LCr
Cl'"'y ' ", '
.ol tCue
Intse HIlgh Moderaot e Minimal
Physlcal Dp-idan~ 2.4 1t48 11. 4
Obwvakn .8 19.6 OA
8octEmot,~loal Ce 2a0 18.0 10.8 4.
RshFIIUorTeaCNno 22.0 1L2 924 4.4
the nursing process, thus allowing a comprehensive asscssment
of actual care required. Such a comprehensive
approach forma the basis for the patient clasification
ysiyem developed a University Hospitals of Clveland,
and this approach was used in the study described here.
Baekgrlound
¡be University Hospitals of Cleveland include a
1000-bed ;ace c medicl center located on the easi
aíde of the city of Cleveland. lts aix specialty hospitals,
il umd om cnra maamet, are closy afrilated
with theb profesional and graduate schools of the healih
adc disciplnes of Case Wern Reserve Univerity.
Tle Medicael Itensive Care Unil (MICU) of Univerity
Hospital conlir0 of two patent care arueu: thc intmelve
cm unit (ICU) where crically ill patienut are
biitally admitte and cared for during the acute tage of
their illns, and the progrceive care unit (PCU) where
p~rtls ar e cared for lfter the acue stae of Iheir illnm.
Both units were desigpd to accommodate 10 patins
ecah with 10 single roomr in the ICU and 5 double
roomu in the PCU, yielding a total posible census of 20
patient for the MICU.
After the firt year of operation at 100 per cent occu-
TABLE 2 PATIENT CARE CATORIE8
ACCORDIN TO TOTAL POC 8CORE
To~ PO 8Moe CdaMV
80or dox,
m0a40
o.~ 40
Mt~-
.~Modmmm
mlml
pancy, the 44 budgeted full-tinic nursing positions
proved to be inadequate to provide safe nursing care in
both Ihe ICU and PCU when both were at 100 per cent
occupancy. For this reason, 4 beds in the MICU were
closed to patients, reducing the total possible census
from 20 to 16 patients for both units. We undertook our
study to determine how the original 20-bed unit could be
restored without resorting to overstaffing or understaffing.
Data collection
We used the department of nursing's Patient Care Categorization
(PCC) assessment tool, with the charge
nurse as the source of data. This classification system
uses four categories of care requirements: physical dependency,
observation required, social/emotional requirements,
and rehabilitation and/or teaching requirement.
Within each of these categories, there are four
levels of required care. The charge nurse chooses which
level of care each patient requires within each of the
four categories.
A total acore, called a PCC score, is then obtained by
adding weighted points for the level of care chosen in
each category. (See Table 1). Based on the ¡otal PCC
acore, a patient is assigned to one of four care categories.
Table 2 lists total PCC scores and their corresponding
care categories.
Using thesc four categories, the nursing department
developed the policy for nurse-patient assignments
(Table 3). This policy provides adequate patient-nurse
rations to ensure safe care and is currently used for
nurslng assignments in the MICU.
The PCC tool had been in use for two years prior to
this study. During that time, ihe PCC assessment was
done one week of each month on the 7:00 A.M. to 3:00
P.M. shlft by the MICU charge nurse; this sample was
The Journl of Nun'in Admitbttion / February 1981