Report on RNHA Autumn 2015 Nursing Matters conference
Dependency level assessment of residents is critical to determining staffing levels
An ability accurately to assess residents’ dependency levels, and to use the information in deciding how many staff should be on duty at different points over a 24-hour cycle, is vital for any care home.
Care homes consultant Rob Fawcett underlined this message in his presentations at both RNHA Nursing Matters conferences.
He said: “Whilst there is no universally accepted tool for making these calculations, managers need to be able to show CQC inspectors they have the requisite number of staff and skill mix available to meet their residents’ needs.”
Describing the RFC dependency system, which has been validated in over 150 care homes, Rob said that it should be seen as a useful aid to clinical judgement. He stressed, however, that tools such as this were designed to support clinical judgement, not replace it.
He added: “Given the significant increase in dependency levels over the past 20 years in both nursing homes and residential care homes, it is important to have access to a system that enables dependency assessments to be converted quickly into staffing levels.”
Acknowledging that nurses are good at assessing individuals’ needs, Rob said they were not necessarily so good at recording that information. Yet, he pointed out, it was through the recording of such information in the records that care homes were judged by CQC inspectors.
Rob stressed the need for much more than an initial assessment of a resident’s needs on admission to the home. “Clinical risk assessments should be reviewed at least monthly,” he argued. “Comprehensive assessments should take place at least every six months, or whenever there is a significant change in circumstances, such as a resident returning from a hospital stay.”
To convert information about dependency assessments into guidance on staffing levels needed, Rob said the first stage was to calculate whether individual residents had high, medium of low needs and then to apply a multiplier in terms of the number of staffing hours required.
“Staffing and skill mix are likely to vary over the 24-hour cycle,” he added, “so it is important to ensure that the right number of staff with the right competences are on duty at the right times. It really is a question of how you deploy your available resources that makes the difference.”
As to the factors to take into account when determining residents’ dependency, Rob listed mobility, fluid needs, continence, skin and wound care, catheter care, emotional and psychological needs, sensory and communication problems, medication and the level of supervision required.
“These and other factors all need to be carefully weighted in order to arrive at an appropriate dependency score,” he said.