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Running head: EFFECT OF IMPLEMENTATION OF AN ACUITY TOOL

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The Effect of Implementation of an Acuity Tool for MedicalSurgical Patients in an Acute Care Setting

Tanya Sobaski, D.N.P.(c), M.S.N, R.N., C.N.E. Scholarly Project

Andrews University Spring 2017

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? Copyright by Tanya Sobaski 2017 All Rights Reserved

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THE EFFECT OF IMPLEMENTATION OF AN ACUITY TOOL FOR MEDICAL-SURGICAL PATIENTS IN AN ACUTE CARE SETTING

A project dissertation presented in partial fulfillment of the requirements for the degree

Doctor of Nursing Practice

by Tanya Sobaski

APPROVAL BY THE COMMITTEE:

_______________________________ Chair: Karen Allen

_______________________________ Member: Cynthia Small

_______________________________ Member: Eileen Willits

_______________________________ External:

_________________________________ Dean, School of Health Professions Emmanuel Rudatsikira _________________________________

_________________________________ Date approved

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DEDICATION

This work is dedicated to my family: To my husband, Mike, for his support, endless hours of listening to me talk about my project, and for being my thesaurus; to my mother, Sylvia, for her hours of proofreading endless drafts of the project; to my father, Olaf, for his encouragement, support, and feedback; to my daughter, Laura, for her feedback from a staff nurse's perspective; and to my sons, Andrew, Will, and Mike for their encouragement and for reminding me not to take myself too seriously.

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ABSTRACT Problem Statement: In an effort to decrease the number of resuscitation events on medicalsurgical units, the use of an acuity tool that incorporated the American Association of Critical Care Nurses (AACN)'s Synergy Framework intervention was studied over a three-month period. This framework aligns patient clinical care needs with nursing care workload indicators. Patients on medical-surgical units are vulnerable for delayed recognition of physiological deterioration. Therefore, they are at increased risk of incurring a resuscitation event. Volume-based nurse staffing does not take into account the necessity of nursing care that is individualized to the patient needs. The American Heart Association-Get With the Guidelines ?, as part of the national Focus on Quality Program, requires hospitals to report resuscitation event occurrences. Purpose: To implement the Chiulli, Thompson, & Reguin-Hartman Acuity Tool in order to decrease the number of resuscitation event occurrences on an Orthopedic/Neurology unit. Method: To utilize a quasi-experimental, non-randomized, quality improvement project implemented on a 32-bed Orthopedic/Neurology Unit over a three-month period, comparing resuscitation event occurrences with the use of the Chiulli, Thompson, & Reguin-Hartman Acuity Tool with the group's performance without the acuity tool. Analysis: Data analysis utilized Chi-square test-for-independence, with a 2x2 contingency table, for variance of the number of patient resuscitation event occurrences with and without utilization of the Chiulli, Thompson, & Reguin-Hartman Acuity Tool. For the sake of analysis, data examined and combined the three months before and after the use of the Chiulli, Thompson, & Reguin-Hartman Acuity Tool. When compared to the three months that the Chiulli, Thompson, & Reguin-Hartman Acuity Tool was employed, it yielded a 1% difference, with a 33% relative risk reduction.

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