Development or Selection and Implementation of the Acuity Tool

(1) Each Acute Hospital shall develop or select an Acuity Tool for each ICU that meets the requirements of 958 CMR 8.00, in order to: (a) Support the determination of whether each ICU Patient requires care by one or more Staff Nurses, or by a Staff Nurse assigned to care for no more than two ICU Patients; and (b) Address the unique care needs and circumstances of the patient population in and physical environment of each ICU at the Acute Hospital. (2) Each Acute Hospital shall establish and document the process for development or selection of the Acuity Tool to be deployed in each ICU, which shall include but not be limited to the following required elements: (a) Formation of an advisory committee to make recommendations to the Acute Hospital on the development or selection and use of the Acuity Tool to be deployed in each ICU, which committee shall be composed of at least 50% Staff Nurses in the ICU in which the Acuity Tool will be deployed who are not Nurse Managers, together with other members selected by the Acute Hospital including but not limited to representatives of nursing management, and other appropriate ancillary and medical staff; (b) A process for the advisory committee to make recommendations on the required elements of the Acuity Tool as set forth in 958 CMR 8.07 and other considerations for the use of the Acuity Tool including but not limited to the following: 1. The defined set of indicators to be assessed by the Acuity Tool, including Clinical Indicators of Patient Stability and other Indicators of Staff Nurse Workload; 2. A method for scoring the defined set of indicators and how scores are tabulated and used in the determination of whether each ICU Patient requires care by one or more Staff Nurses, or by a Staff Nurse assigned to care for no more than two ICU Patients; and 3. Critical Environmental Factors. (c) A process for Staff Nurses to participate in the testing of, validation of and recommendations for revision to the Acuity Tool prior to implementation; and (d) A process for the Acute Hospital to address and respond to recommendations of the advisory committee regarding the selection or development and use of the Acuity Tool pursuant to 958 CMR 8.06. (3) Each Acute Hospital shall develop written policies and procedures for implementation of the Acuity Tool to be deployed in each ICU, which shall include but not be limited to: (a) Assessment of patient stability and how the resulting Acuity Tool score will be used to support the determination of the appropriate Patient Assignment in the ICU, consistent with the requirements of 958 CMR 8.00; and (b) Periodic review and evaluation of the implementation of the Acuity Tool. (4) Within the requirements of 958 CMR 8.06, nothing shall prevent an Acute Hospital with multiple ICUs from seeking administrative efficiency in the development or selection of Acuity Tools by, for example, duplicating non-Staff Nurse members selected by the Acute Hospital pursuant to 958 CMR 8.06(2)(a) on advisory committees or considering a common format or platform for Acuity Tools used in the Acute Hospital.