Validation of an Acuity Measurement Tool for Maternity Services

Authors: Cherryl Lowe

Abstract:

Background - The TrendCare Patient Dependency System is currently used by a large number of maternity Services across Australia, New Zealand and Singapore. In 2012, 2013 and 2014 validation studies were initiated in all three countries to validate the acuity tools used for women in labour, and postnatal mothers and babies. This paper will present the findings of the validation study. Aim - The aim of this study was to; identify if the care hours provided by the TrendCare acuity system was an accurate reflection of the care required by women and babies; obtain evidence of changes required to acuity indicators and/or category timings to ensure the TrendCare acuity system remains reliable and valid across a range of maternity care models in three countries. Method - A non-experimental action research methodology was used across maternity services in four District Health Boards in New Zealand, a large tertiary and a large secondary maternity service in Singapore and a large public maternity service in Australia. Standardised data collection forms and timing devices were used to collect midwife contact times, with women and babies included in the study. Rejection processes excluded samples when care was not completed/rationed, and contact timing forms were incomplete. The variances between actual timed midwife/mother/baby contact and the TrendCare acuity category times were identified and investigated. Results - Thirty two (88.9%) of the 36 TrendCare acuity category timings, fell within the variance tolerance levels when compared to the actual timings recorded for midwifery care. Four (11.1%) TrendCare categories provided less minutes of care than the actual timings and exceeded the variance tolerance level. These were all night shift category timings. Nine postnatal categories were not able to be compared as the sample size for these categories was statistically insignificant. 100% of labour ward TrendCare categories matched actual timings for midwifery care, all falling within the variance tolerance levels. The actual time provided by core midwifery staff to assist lead maternity carer (LMC) midwives in New Zealand labour wards showed a significant deviation to previous studies. The findings of the study demonstrated the need for additional time allocations in TrendCare to accommodate an increased level of assistance given to LMC midwives. Conclusion - The results demonstrated the importance of regularly validating the TrendCare category timings with actual timings of the care hours provided. It was evident from the findings that variances to models of care and length of stay in maternity units have increased midwifery workloads on the night shift. The level of assistance provided by the core labour ward staff to the LMC midwife has increased substantially. Outcomes - As a consequence of this study, changes were made to the night duty TrendCare maternity categories, additional acuity indicators were developed and times for assisting LMC midwives in labour ward increased. The updated TrendCare version was delivered to maternity services in 2014.

Keywords: Maternity, acuity, midwifery research, midwifery workloads.

Digital Object Identifier (DOI): doi.org/10.5281/zenodo.1100619

References:

[1] M.A. Blegen, C.J. Goode, I. Reed, “Nursing Staffing and Patient Outcomes”, Journal of Nursing Research, Vol. 4, No. 7, pp 43-50, 1998.
[2] K.M. Parrinello, “Accounting for Patient Acuity in an Ambulatory Surgery Centre”, Journal of Nursing Economics, Vol. 5, No. 4, pp 167- 172, 1987.
[3] K. Harper, C. McCully, “Acuity Systems Dialogue and Patient Classification System Essentials”, Journal of Nursing Administration, Vol. 31, No. 4, pp 248-299, 2007.
[4] V. Plummer, “An Analysis of Patient Dependency Data Utilizing the TrendCare System,” Doctoral thesis, Monash University, Melbourne, Australia 2005.
[5] E.J.S. Hovenga, “Development of the Patient Assessment and Information System (PAIS), Doctoral thesis, University of New South Wales, 1994.
[6] J.D. Thompson, “The Measurement of Nursing Intensity”, Health Care Financing Review, Nov. Annual Supplement No. 6 pp 47-55, 1984.
[7] A.R. Gault, “The Aberdeen Formula as an Illustration of the Difficulty of Determining Nursing Requirements”, International Journal of Nursing Studies, Vol. 19, pp 61-77, 1982.