Dd Form 2552 - Workload Management System For Nursing - Psychiatric Worksheet Page 2
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1
2WORKLOAD MANAGEMENT SYSTEM FOR
SECTION II - ADDITIONAL DATA
NURSING - PSYCHIATRIC WORKSHEET
1. ACUITY TABLE
2. TYPE OF PATIENT (X as applicable)
e. ANTEPARTUM/
CATEGORY
POINTS
a. MED/SURG
POSTPARTUM
0
O
I
1 - 12
ENTER DATE, RN INITIALS,
b. ICU
f. PEDIATRIC
II
13 - 31
AND LAST FOUR SSN
III
32 - 63
c. NURSERY
g. PSYCHIATRIC
IV
64 - 95
V
96 - 145
ACUITY
POINT
SECTION I - CRITICAL INDICATORS (Continued)
d. NEONATAL ICU
VI
146 - 262
CODE
VALUES
COMMENTS
6. THERAPEUTIC INTERVENTIONS/ACTIVITIES
135
Purposeful interaction - 15 minutes
2
136
Purposeful interaction - 30 minutes
4
137
Purposeful interaction - 45 minutes
6
138
Purposeful interaction - 1 hour
8
139
Sensory deprivation - blind, deaf, retarded, etc.
6
140
Group activity, on unit - staff ratio 1:4-5
2
141
Group activity, off unit - staff ratio 1:4-5
2
142
Group activity, meeting - staff ratio 1:4-5
2
7. TEACHING
143
Teaching - group per hour
2
144
Teaching - individual per 30 minutes
4
8. CONTINUOUS
145
Patient requiring 1:1 coverage all shifts
96
0
0
0
0
0
SUBTOTAL C POINT VALUE
0
0
0
0
0
SUBTOTAL A POINT VALUE
0
0
0
0
0
SUBTOTAL B POINT VALUE
0
0
0
0
0
TOTAL POINT VALUE
PATIENT ACUITY CATEGORY
DD Form 2552, FEB 92
Page 2 of 2 Pages
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