Birthing Center Patient Acuity Tool for AWHONN Standard Staffing
By: Scout Sanders & Ashley Nguyen
Illinois Wesleyan University School of Nursing
Literature Review
Opportunity for Change
The current patient acuity tool does not accurately reflect the staffing needs of
labor, delivery, recovery, postpartum (LDRP), and nursery patients, which has led
to inadequate staffing levels. To achieve improved nurse staffing and patient
safety an SBAR will be submitted for approval by the administration.
AWHONN Staffing Standards
A quality improvement project was initiated at The Johns
Hopkins Hospital to develop a patient acuity tool for their
labor and delivery unit to meet AWHONN staffing
guidelines. The data supported a budgetary increase in
nurse staffing and created a flexible scheduling system to
serve the needs of patients. This patient acuity tool is
implemented in all the hospital system’s labor and delivery
units (Jones & Hall, 2022).
Evidence for Practice Change
Birthing Center staff perceive they are not following The Association of Women's
Health, Obstetric and Neonatal Nurses (AWHONN) staffing standards leading to
result in:
Inadequate
staffing
levels.3
- Missed nursing
care such as
prenatal record
review.3
- Initial
assessments &
conducting a
thorough history. 3
- Timely maternal and
fetal assessments
including progress of
labor & labor
support.3
- Bedside
attendance,
repositioning,
comforting, and
“being with” the
patient.3
According to St Laurent, D., Santovasi, H., & MacDonald,
K., their OB department managed to decrease the number
of hours worked per equivalent patient days from 23 to
18.7, resulting in significant cost savings. The use of their
AWHONN staffing standards adhering patient acuity tool
for a period of six months was responsible for achieving
this reduction. The initial projected savings were $800,000
per year, but the actual savings ended up being
$1,300,000 for the hospital. Which would benefit SJMC
greatly. 1,2,4
Implementation
The SBAR will be submitted to the SJMC
administration for approval.
Staff in-service presenting evidence for
change
Evaluation
Purpose of SBAR
The use of a new patient acuity tool
according to AWHONN standards can help
to accurately assess the needs of patients
specific to the Birthing Center at SJMC and
determine appropriate staffing levels to
ensure that patients receive safe and highquality care.
Pilot new patient
acuity & staffing tool
A study approved by New York University and the
University of California San Francisco found that missed
nursing care, missed skin-to-skin, and breastfeeding within
the first hour of birth, are sensitive to nurse staffing. The
evidence also provides that exclusive breastfeeding rates
are a nurse-sensitive outcome predicted by hospitals’
compliance with AWHONN staffing standards (Lyndon et
al., 2022).
Charge nurses on OB will assess staffing 2x/shift using the new patient acuity
tool according to AWHONN staffing standards, and track staffing/patient/cost
outcomes for 2 months.
• To evaluate the effectiveness of the change
• Staff development post test will look at consistency with filling
out the patient acuity & staffing tool.
• Monitor SJMC Birthing Center nurse to patient ratio
• Follow-up with all SJMC nurses & staff involved in the change for feedback
Improve nurse to
patient ratio following
AWHONN standards
Improve patient
outcomes
Increase hospital
savings.4
References
1.
Jones, L. W. & Hall, V. L. (2022). Acuity-Based Staffing in Labor and Delivery Using Electronic Health Record Data. The American Journal of Maternal/Child Nursing, 47(5), 242-248.
https://doi.org/10.1097/NMC.0000000000000838
2. Lyndon, A., Simpson, K., Spetz, J., Zhong, J., Gay, C., Fletcher, J. & Landstrom, G. (2022). Nurse-Reported Staffing Guidelines and Exclusive Breast Milk Feeding. Nursing Research, 71(6),
432-440. https://doi.org/10.1097/NNR.0000000000000620
3. Standards For Professional Registered Nurse Staffing For Perinatal Units. (2022). Journal of Obstetric, Gynecologic & Neonatal Nursing, 51(4). https://doi.org/10.1016/j.jogn.2022.02.003
4. St Laurent, D., Santovasi, H., & MacDonald, K. (2015). Using an acuity tool to maintain productivity while adhering to AWHONN’s perinatal nurse staffing guidelines. Journal of Obstetric, Gynecologic &
Neonatal Nursing, 44. https://doi.org/10.1111/1552-6909.12713