The measurement of the intensity of nursing care required by a patient.

For the purpose of this work, we use the term acuity as an umbrella term which encompasses other terms such as dependency, intensity and complexity to describe the expanse of care that a patient requires based on their holistic needs. 

The term acuity has two main attributes: 

1. Severity, which indicates the physical and psychological status of the patient

2. Intensity, which indicates the nursing needs, complexity of care and the corresponding workload required by a patient, or group of patients.

Bilevel Positive Airway Pressure.

Central Nervous System.

Forming a professional judgement that a patient, or group of patients, require a similar level of supervision. 

Professional judgement must be used when determining patients’ levels of acuity, bearing in mind that the nursing care they receive will need to be shared between the patients within that bay. 

Example 1: In a two bedded bay, where two patients are cohorted and cared for by one member of staff for 24 hours, this would equate to each patient receiving one-to-one care for the majority of care, so each patient would be categorised as a level 4. 

Example 2: when cohorting several patients together in a nursing bay to enhance the level of supervision available to them, this doesn’t mean that they all need the same level of supervision. Cohorted patients may also have different levels of acuity and so it would be appropriate for those patients to be categorised at different levels.

Continuous Positive Airway Pressure.

Electrocardiogram.

Glyceryl Trinitrate.

Health Care Support Worker.

Health Education and Improvement Wales.

Intravenous.

Inravenous Infusion.

Describe in simple terms the typical condition of the patient and types of care.

Routine Care

The patient has a clearly identified problem, with minimal other complicating factors.

Care Pathways

The patient has a clearly defined problem but there may be a small number of additional factors that affect how treatment is provided.

Complex Care

The patient may have a number of identified problems, some of which interact, making it more difficult to predict the outcome of any individual treatment.

Urgent Care

The patient is in a highly unstable and unpredictable condition either related to their primary problem or an exacerbation of other related factors.

One-to-One Care

The patient requires at least one-to-one continuous nursing supervision and observation for 24 hours a day.

The National Acuity Audit is a bi-annual audit of patient acuity across NHS Wales.

For the purpose of the bi-annual audit, patient acuity data is collected during the months of January and June, at 15:00 hrs each day, as stipulated by the Chief Nursing Officer. The more data that is collected, the more robust and reliable picture of a ward’s caseload will be obtained.

Data must be recorded on every patient, 7 days a week, for the full calendar month for the period of the acuity audit.

National Early Warning Score(s).

Nasogastric tube.

National Health Service.

A registered nurse who has a live registration on sub parts 1 or 2 of the Nursing and Midwifery Council register.

The total number of registered nurses plus the number of persons providing care under the supervision of, or discharging duties delegated to them by a registered nurse, e.g. HCSWs. The nurse staffing level refers to the required establishment and the planned roster.

The Nurse Staffing Level (Wales) Act 2016 became law in Wales in March 2016. The Act requires health service bodies to make provision for an appropriate nurse staffing level wherever nursing services are provided, and to ensure that they are providing sufficient nurses to allow them time to care for patients sensitively. This requirement extends to anywhere NHS Wales provides, or commissions a third party to provide, nurses.

Technical detail about the condition and interventions required at each level.

Refers to applying knowledge, skills and experience in a way that is informed by professional standards, law and ethical principles to develop a decision on the factors that influence clinical decision making in relation to patient safety.

Health boards/trusts are required to consider quality indicators which are a robust measure of those factors considered to demonstrate the outcomes for patients and staff. Quality indicators reflect patient outcomes that are deemed to be nursing-sensitive.

Total Parenteral Nutrition

The method used when calculating the nurse staffing level. Triangulation is a technique that facilitates validation of information from the following three sources of data through a process of cross verification:

• Patient acuity
• Professional judgement
• Quality indicators

Data from each of these three sources are taken into account when calculating the nurse staffing level.

Vacuum-assisted closure.

Displays data collected from wards during acuity audits. Data is displayed using using bar charts and graphs. Data displayed includes: patient acuity, patient flow, and nurse staffing.

The Welsh Levels of Care are a key component of the operational guidance developed for the Nurse Staffing Levels (Wales) Act 2016.