Vital Signs
Question Received:
Response:
We are researching the frequency of post operative vital signs after the patient leaves the recovery room to update our policy and I am having great difficulty finding any information on this topic in regard to what other institutions routines are. Do you have any information or suggestions for finding out this information?
17th January 2000
Searches of the British Nursing Index, RCN Journals Database and PubMed archives revealed the following publications that may be helpful:
Davies, M.J., and Normura,
L.A. (1990) Vital signs of class 1 surgical patients. Western Journal of
Nursing Research, 12(1), 28-41 (Feb).
(Research into the appropriateness of the frequency of nurses' assessment of
vital signs.)
Hanney, B. (1992)
Post-operative observations. Journal of Clinical Nursing, 1(4), 174 (Jul)
(One ward's rationale for post-operative assessment.)
Moller, J.T., Pederson, T.,
and Johansen, S.H. (1989) Monitoring routines at Danish anesthesia
departments. [Article in Danish] Ugeskr Laeger, 151(46), 3069-3071 (Nov 13).
(Monitoring of vital signs in 84 Danish anaesthetic departments - the
questionnaire investigation revealed great variation in the monitoring and
supervision routines.)
Reid, B. (1991) Developing
and documenting a qualitative methodology. Journal of Advanced Nursing,
16(5), 544-551 (May).
(Research process involved in investigating rationale behind nursing
observations of vital signs.)
Toms, E. (1993) Vital
observations. Nursing Times,. 89(51), 32-34 (22 Dec).
(Findings from a review of research literature on timing and accuracy of
monitoring patients' vital signs by nurses in general hospital wards.)
(NB: Keep in mind that ‘vital signs/observations’ can be taken to mean those observations and recordings that are reserved for patients with acute neurological disturbances.)
Notes
The frequency with which observations are made of the patient’s vital signs after leaving the Recovery Room will reflect a balance between:
Maintaining the frequency of observations instigated by the nurses in the Recovery Unit, with modification according to changes in the patient's condition
Agreement on the frequency with which observations should be conducted so that the patient's need for rest and comfort is achieved without safety being compromised
Generally speaking 'core' objective clinical recordings such as respiratory rate, pulse oximetry, blood pressure and pulse within the Recovery Unit are taken and recorded every 5 to 15 minutes, depending upon the kind of surgery that has been performed. As the patient's condition stabilises the interval between observations is extended, until a point is reached where the patient is considered to have recovered sufficiently from the immediate effects of the anaesthetic and surgical procedure to return to the ward. If the patient’s condition does not improve as expected it may be necessary to transfer her/him to the Intensive Care Unit.
Generally on return to the surgical ward a baseline set of objective recordings is taken. There are several approaches which might be considered with the general aim being to maintain the patient's safety and achieve a smooth transition from a state of high dependency towards independence.
Suggestions
Unless instructions/guidelines to the contrary are received from the Recovery Unit:
Adopt an individual (holistically based) policy. For example the person responsible for caring for the patient (Primary Nurse) is encouraged to use her/his judgement with regard to the range and frequency for conducting objective recordings (see Hanney 1992, listed above)
Discuss with members of the ward team the approach which they feel is most desirable (consensus management)
Adopt a standardised approach, for example objective recordings made every 5 to 15 minutes for a predetermined period. List criteria that must be met before the frequency of the recordings can be changed. (This approach can however make 'key' issues in care become a set of routine tasks to perform.)
Whatever policy is adopted monitor its progress and modify practice in the light of the findings.