| Sumario: | Significance & Background: Infusion center acuity tools help assess patient's level of care needed, allowing nurses to provide safe, effective interventions. Incorporating these tools into staffing decisions is essential, as it ensures that staffing levels match the complexity of patient treatments. This alignment is crucial for improving patient outcomes, minimizing errors, enhancing nursing job satisfaction, and reducing nursing turnover. Prior acuity tools reported in the literature lack rigorous testing and have not shown continued consistent application post-implementation by nurses. Purpose: The project goal was to test a redesigned acuity tool to support staffing in oncology and non-oncology infusion clinics across a large healthcare system with the primary aim of ensuring safe, high-quality patient care. Interventions: A team of infusion nurse managers, research nurse scientists (RNS), and subject matter experts (SME) collaborated to transform an acuity tool originally developed in 2006--previously used in only a few departments-- into a standardized system-wide acuity tool. Design considerations were made to ensure that as infusion therapies change over time, the acuity tool's criteria for ratings were generalizable and could encompass future changes without frequent revisions. The revised acuity tool was rigorously tested by RNSs and demonstrated high inter-rater reliability and content validity. Pre-implementation, all nurses who would be using the acuity tool completed an interactive one- hour training session developed by nurse educators and a post-test featuring case studies to ensure understanding of application. Post-implementation, an analysis was conducted across the system's infusions centers to assess how nurses' daily patient acuity ratings using the redesigned acuity tool compared to the acuity tool's recommendations. SMEs reviewed the data to identify any discrepancies between assigned acuities and the acuity tool's recommendations. Results: Post-implementation reliability analysis (n=1,977 acuity ratings) demonstrated that 90% of nurses' acuity ratings agreed with the acuity tool's recommendations. Discussion: The results showed that nurses consistently applied the acuity tool across oncology and non-oncology infusion centers. This work enabled all twenty-one infusion centers to use a standardized, definition-based acuity tool, creating a common language across diverse patient populations. Future implications include ongoing evaluation of the impact of tracking acuity by site and nurse to align resources more effectively, developing financial metrics that reflect patient needs rather than volume, and continuing to assess how the acuity tool informs nursing staffing and hiring decisions across the system's infusion centers.
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