www.acss.min-saude.pt
www.acss.min-saude.pt
Patient Classification System
based on
Dependency of Nursing Care
Cristina Duarte Paulino
LisbonOctober 2008
www.acss.min-saude.pt
Challenge
●Provide high quality care
●Contain the costs
More flexibility from de organisations
More rational use of the existing structures
Patient Classification System based on Dependency of Nursing Care (PCS/N)
www.acss.min-saude.pt
History
1982
Ministry of Health
Information System to Hospital Management
Patient Classification System based on
Dependency of Nursing Care Levels
Patient Classification System based on Dependency of Nursing Care (PCS/N)
www.acss.min-saude.pt
History
Wide asymmetry regarding the nurses distribution
? Were the differences justified?
? Were they a consequence of an inefficient planning?
Patient Classification System based on Dependency of Nursing Care (PCS/N)
www.acss.min-saude.pt
Project
Create results
Allow a more adjusted allocation of nurses
Meeting the real needs of the patients
Patient Classification System based on Dependency of Nursing Care (PCS/N)
www.acss.min-saude.pt
Goals
Development of tools to measure the number of nursing
hours needed for each patient
Train hospital managers in using the information
Patient Classification System based on Dependency of Nursing Care (PCS/N)
www.acss.min-saude.pt
Task
Choose a patient classification system
Subjective
Objective
Patient Classification System based on Dependency of Nursing Care (PCS/N)
www.acss.min-saude.pt
Concept
PCS/N consists of classifying inpatients by critical
activity indicators, according to their nursing care needs
Patient Classification System based on Dependency of Nursing Care (PCS/N)
www.acss.min-saude.pt
Characteristics
Individual
Global
Flexible
Prospective
Daily
Objective
Easy to understand
Patient Classification System based on Dependency of Nursing Care (PCS/N)
www.acss.min-saude.pt
Constraints
Complexity and high costs of construction
Advantages
Accuracy in calculating the number of minutes really
required
Easiness of its implementation
Patient Classification System based on Dependency of Nursing Care (PCS/N)
www.acss.min-saude.pt
The Development of Tools: Phases
1. Identify the main nursing activities of direct care
2. Check the percentage
3. Ascertain the standard time
4. Determine the frequency of the direct care provision
5. Validate the model of the patient classification chart
6. Identify the indirect care of nursing activities
7. Develop a conversion table
Patient Classification System based on Dependency of Nursing Care (PCS/N)
www.acss.min-saude.pt
Direct care
Activities which mean the provision of care to a patient to
satisfy his/her daily needs
Indirect care
Activities which being part of the care provided to patients
are cannot be identified as specifically to one patient
Patient Classification System based on Dependency of Nursing Care (PCS/N)
www.acss.min-saude.pt
Basic Formula
Total Care
Hours
Direct nursing
hour care
(listed and unlisted)
Indirect nursing
hour care
Patient Classification System based on Dependency of Nursing Care (PCS/N)
= +
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Patient Classification System based on Dependency of Nursing Care (PCS/N)
Objective of the PCS/N
Provide an information tool, allowing the rational
management of the human resources through the
optimisation of the available nursing staff
www.acss.min-saude.pt
Goals of the application of the PCS/N
Optimise the number of nurses available
Plan the delivery of nursing care
Identify the needs regarding the nurses staff
Adjust the allocation of the hospital staff
Patient Classification System based on Dependency of Nursing Care (PCS/N)
www.acss.min-saude.pt
Organizational requirements
Provision of nursing care based on individual method
Existence of the nursing process model
Existence of a definitions and procedures manual
Applied to patients admitted for a 24 hour period or more
Patient Classification System based on Dependency of Nursing Care (PCS/N)
www.acss.min-saude.pt
Application
The method is implemented in 52 of the 100 hospitals
from the Portuguese Health System and also the
Rehabilitation Centre of Alcoitão
Patient Classification System based on Dependency of Nursing Care (PCS/N)
www.acss.min-saude.pt
• BRAGANÇA
• MACEDO DE CAVALEIROS
• CHAVES
• PONTE DE LIMA
• BRAGA• FAFE
MIRANDELA
FAMALICÃOSANTO TIRSO
• LAMEGO• PORTOIPO
OLIVEIRA DE AZEMEIS
• VISEU
• GUARDA• SEIA• TONDELA
• COIMBRAFIGUEIRA DA FOZ
• COVILHÕ FUNDÃO
• CASTELO BRANCO
PONTA DELGADA• TOMAR
• ABRANTES• TORRES NOVAS
• PORTALEGRE
• ELVAS
• ÉVORA
• BEJA• SERPA
• ALCOBAÇA
• TORRES VEDRAS
H. T.VEDRAS
H. BARROH. CASCAIS
H. PAREDE
• LISBOACASCAIS ALCOITÃO
H. CURRY CABRAL
H. CAPUCHOS
H. S. JOSÉ
H. SANTA CRUZ
H. EGAS MONIZ
H. S.FRANCISCO XAVIER
IPO
• MONTIJO
• BARREIRO
• SANTIAGO DO CACÉM
LAGOS • PORTIMÃO
• FARO
• FUNCHAL
H. CRUZ CARVALHO
H. MARMELEIROS
HUC
CHC
IPO
Patient Classification System based on Dependency of Nursing Care (PCS/N)
www.acss.min-saude.pt
Implementation
Internal Medicine (cardiology, gastroenterology, infectious
diseases, nephrology, neurology and geriatrics)
Surgery (gynaecology, urology, neurosurgery)
Obstetrics
Orthopedic
Oncology
Pediatrics
Rehabilitation
Patient Classification System based on Dependency of Nursing Care (PCS/N)
www.acss.min-saude.pt
Management indicators
1. Number of hours of nursing care required per inpatient/per
day (HCR/ID)
2. Number of hours of care provided by inpatient/by day
(HCP/ID)
3. Staff workload rate
Patient Classification System based on Dependency of Nursing Care (PCS/N)
www.acss.min-saude.pt
Patient Classification System based on Dependency of Nursing Care (PCS/N)
HCR/ID evolution
0
1
2
3
4
5
6
7
20
03
20
04
20
05
20
06
20
07
Anos
HCD/ID
Internal Medicine
Surgery
Orthopedics
Obstetrics
Pediatrics
www.acss.min-saude.pt
Patient Classification System based on Dependency of Nursing Care (PCS/N)
Nursing care hours required per inpatient/per day
(HCR/ID) 2007
0
1
2
3
4
5
6
7
HCR/ID
5
6,21
4,925,43
3,89 Surgery
Internal Medicine
Pediatrics
Orthopedics
Obstetrics
www.acss.min-saude.pt
Internal Audits
Ensure the reliability of the data generated in each
service and verify the accomplishment of the patients’
classification regulations
External Audits
Ensure the reliability of the data generated per hospital
Patient Classification System based on Dependency of Nursing Care (PCS/N)
www.acss.min-saude.pt
Conclusion
The most important achievement of the PCS/N is its
contribution for improving the organisational and
managerial systems of the hospitals
The outcomes indicate the shortness of nurses in
internal medicine units
The allocation of the available resources in conformity to
the patients’ real needs
Patient Classification System based on Dependency of Nursing Care (PCS/N)
www.acss.min-saude.pt
Conclusion
The influence of the organisational culture in a very
positive way
The existence of an information system available
Patient Classification System based on Dependency of Nursing Care (PCS/N)
www.acss.min-saude.pt
Future goals
1. Work in new patient’s classification charts
2. Actualization of the existing charts
3. Improve the informatics tool to obtain an automatic
patient classification
4. Total implementation of the PCS/N in the National
Health Care Hospitals
Patient Classification System based on Dependency of Nursing Care (PCS/N)