^{Just as the former AWHONN staffing guidelines had been in existence for several decades, our staffing methods of assigning postpartum staff were dated.  Rising acuity and complexity of delivered mother/infant dyads highlighted the necessity to better define the level of nursing care required.  Our stagnant methods of quick looking comparison of staff to patient numbers, then assigning care providers based on room proximity, mode of infant birth, and length of stay had long since outlived their usefulness.  Though commercial patient classification software exists, most programs are based on medical-surgical models, which fail to adequately address sudden changes in census and acuity common to our maternity population.  In addition, literature is scant on establishing infant acuity in a normal newborn setting.  Assigning care for infants considering gestational age, neonatal abstinence and feeding issues presents a formidable challenge.}

Proposed change:

^{To address the difficulty of appropriate patient care assignments, separate acuity classification tools for mothers and infants were developed.  Used in conjunction, these tools serve as guidelines in determining appropriate levels of care for both patients.  Maternal Acuity is based on method of delivery, existing physical complications, and psychosocial barriers and concerns.  Newborn acuity is based on congenital and birth complications, transitional instability plus feeding readiness and effectiveness.  Both tools assist in aligning staffing patterns with the 2010 AWHONN guidelines of 1:3 nurse to mother/infant dyads.  Appropriate levels of care as determined by the tools, provide a framework for assuring optimal staffing that meets the needs of staff and patients.}

Implementation, outcomes and evaluation:

^{The tools were implemented in June, 2011.  Initial feedback has been very positive; staff indicate the classification system has made assignments more manageable.  Following the pilot period, the tools will be tweaked, based on suggestions from nurses.  With over half of our staff certified as Lactation Counselors, our goal is to assure that breastfeeding couplets receive this additional skilled support.  Implementing use of the tools has not been without challenge.  As staff adjust to appropriately assigning classification levels to mother and infant, patient acuity remains fluid, causing changes in levels of care determined.  Data collection is ongoing, with patient and staff satisfaction, breastfeeding support and breastfeeding exclusivity at discahrge, 3 and 6 months all being measured}.

Implications for nursing practice:

^{Appropriate acuity based assignments benefit both patients and nurses by promoting safe, effective care within the 2010 AWHONN guidelines}.

Keywords: patient classification, acuity, nursing workload