Patient

Classification
System
O. Francis-Ruddock
Definition
 The Patient Classification System refers to the
categorization of patients according to their
assessed nursing care requirements or level of
dependency over a specified period of time for a
give ward.
 A system for distinguishing among different
patients based on their acuity (level of need or
dependency of an individual patient), functional
ability or resource needs (Kelly, 2008)
Overview of Patient Classification
Systems
 Itis a measurement tool used to articulate
the nursing workload for a specified
patient or group of patients over a
specified period of time.
 Classification data can be used to predict
the amount of nursing time needed based
on the patient’s acuity.
 As the patient becomes sicker, the acuity
level rises, meaning the patient requires
more nursing care
Benefits of a Patient Classification
System
 It matches skills and time to patient care
requirements
 It provides for more efficient allocation and
utilization of existing nurse manpower and
cost control in nursing within the health
sector.
 The system permits more flexibility in
assigning nurses to individual units
 It provides a system for monitoring standards
of care
Organization of the System
 The system is organized into three
depending on the area of nursing care.

1. Medical, Surgical, Maternity, Pediatric and

Geriatric

2. Psychiatric/Mental Health

3. Intensive Care Unit

Critical Care Indicators
 Patients are classified according to their
need for nursing care in the following
critical care areas:
 Hygiene/Elimination
 Nutrition
 Mobility/Activity
 Treatment/Monitoring/Observation
 Teaching
 Emotional Support
Hygiene/Elimination
 This
critical care indicator refers to the
nursing care required by the patient to
complete all aspects of his personal
hygiene/elimination needs including
shower/bath, skin care, hair grooming, nail
care, teeth and mouth care, bed making,
elimination requirements and monitoring
of output.
Nutrition
 Thiscritical care indicator refers to the
nursing care required in order to provide
for nourishment and includes items such
as menu selection, assistance with,
supervision of and total feeding, assisting
patient with tray arrangements, cutting
food, feeding, forcing oral fluids, tube
feeding, monitoring intake, providing
water and juices.
Mobility/Activity
 Thisindicator refers to the nursing care
required by the patient to keep him/her
physically active within the limitations of the
disease or condition. It includes walking with
or without the use of aides such as
wheelchair, cane, crutches, walkers;
wheeling the patient or assisting or
supervising ambulation; turning or
repositioning the patient; deep breathing,
coughing, active or passive range of motion
exercising, swinging legs on edge of bed.
 The intent is therapeutic as compared to
transporting the patient to a specified
destination
Treatment/Monitoring/Observation
 This indicator refers to the patient’s
requirement for administration of
medications by various routes;
treatments of all types e.g.. IVI, oxygen
administration, monitoring of vital signs
and other indices, clinical observation
and assessment.
 It includes treatments and procedures
such as: irrigation of bladder, pre op
care, sterile or non sterile dressing,
catheterization; enema etc.
Teaching
 This indicator refers to the educational
needs of the patient/family and includes
three main areas of teaching:
a) Health Teaching
b) Special Teaching for chronic disease regime
compliance
c) Therapeutic teaching for invasive/ non-invasive
therapy; preparation for discharge.
 Each patient may require all three or one.
However, all patients require health teaching or
aspects of.
 It includes explanation of procedures or
treatments, demonstrations, pre op teaching,
discharge planning
Emotional Support
 This indicator is provided to incorporate
psychological/emotional support
requirements from the nursing staff to a
patient/family as separate and distinct
from educational needs of the
patient/family.
 It includes support and reassurance,
calming an agitated patient,
psychological counseling.
More on Critical Care Indicators
 Each critical indicator has four factors or
determiners.
 Each factor is rated separately and then
combined to generate a category or
dependency level
 The patient is designated as requiring
minimal, moderate, extensive or very
extensive nursing time involvement
Category I – Minimal Level
 The patient is independent in function and
is physically capable of caring for
him/herself.
 Requires minimal nursing supervision
 Treatment programme may require minimal
monitoring and simple health teaching and
or reinforcement of previous teaching – less
than 5 minutes by nursing staff.
 Demands on nursing time is minimal
Category II – Moderate Level
 The patient requires an average or
moderate amount of nursing care
including some nursing supervision and
encouragement.
 The patient may require some assistance
with personal care needs, as well as
minimal observation, monitoring and
treatment, and instructional programme
for 5 – 10 minutes.
 Demands on nursing time is moderate.
Examples of Category II Patients
A patient beyond the acute stage of
his disease or surgery.
A 3-4 day post op cholecystectomy
patient
A diabetic patient for reassessment
An independent patient requiring
extensive investigative procedure
Category III – Extensive Level
 The patient requires a greater than
average amount of nursing care including
nursing supervision, encouragement and
almost complete assistance to meet
personal care needs.
 The patient usually requires medical
support and sometimes the use of special
equipment as well as instructional
programme for 10-20 minutes.
 Demands on nursing time is extensive.
Examples of Category III Patients
A patient after the acute phase of CVA
(residual paralysis)
 A first day post op radical mastectomy,
hysterectomy or cholecystectomy
 A debilitated, dependent elderly person
 A newly diagnosed diabetic patient
requiring extensive health and treatment
regime compliance teaching and support
from nursing staff.
Category IV – Very Extensive Level
 The patient requires very frequent to
continuous nursing care along with close
supervision by medical personnel and/or
other health team members, and/or support
from technical equipment.
 The instruction programme may last from 20-
30minutes.
 Demands on nursing time is very extensive,
on a 1:1 basis.
 Requires time consuming nursing activities
such as multiple treatments occurring
simultaneously and/or constant observation,
vital signs and other indices monitoring.
Examples of Category IV Patients
A quadriplegic patient in early
rehabilitative stage
 A severely burnt patient
 A comatose patient
 A severe accident case
 Confused or uncooperative patient
When are patients classified
 The classification of patient dependency
for nursing care should be undertaken as
part of the daily evaluation and planning
of patient needs.
 It should therefore form an integral part of
nursing administration and ward
management
Reference
 Kelly,P. (2008). Nursing Leadership &
Management. Australia: Delmar Cengage
Learning.
 Reid, U. (1989). Patient Classification
System. Commonwealth Caribbean.
Barbados: PAHO/WHO