Implementation of Daily NHPPD Calculator in the Acute Care Setting

Practice Problem: In the United States, it is estimated that hospitalized patients experience an adverse event that require a rapid response and/or code blue event in 3% to 18% of hospitalizations. PICOT: In the adult medical-surgical inpatient (P), does the implementation of a daily NHPPD calculator (DNC) (I) compared to an annual staffing methodology for calculating NHPPD (C) reduce rapid response calls, code blue episodes, and unplanned admission to critical care (O) over 8 weeks (T). Evidence: Seven studies provided evidence that implementation of staffing methodology, nursing surveillance, and nurse staffing that supports meeting targeted nursing hours per patient day (NHPPD) decreased patient adverse events such as rapid responses, code blue episodes, and unplanned transfers to critical care. Intervention: The project implemented a daily NHPPD calculator (DNC). The DNC provided adequate daily staffing. Outcome: The result of the two-tailed independent samples t-test was not significant based on an alpha value of 0.05, t (73) = 0.61, p = 0.543. Although not statistically significant, the number of codes and unplanned transfers decreased. The DNC proved to be clinically significant to ensure nurse staffing resources were allocated appropriately and has been adopted at the organization. Conclusion: The daily NHPPD calculator provided an objective tool that facilitated resource utilization and staff sharing. Evidence supports use of the daily NHPPD calculator to meet staffing needs, which correlated to improved nurse surveillance and care.