Standard Times for Vital Signs

  1. Currently, our ER Department is in a flux. New management with new toys, more personel, ect... I am trying to determine if there are standard times for vital signs. In my level 1 days, our fast track pts. (ESI level 4&5) got a full set of vitals at triage and discharge. Our non-monitored pts, (basic med-surg canidates, ESI 3) got vitals q4 hrs. Our stable monitored pts (ESI 2 and some 3s w/ cardiac hx) were q1hr. And our unstable or pts that became unstable or intubated were at a minimum q15min.
    The main reason I am asking, I am new to this job but have 8 years of nursing with 2 in a level 1 ER experience, and am butting heads w/ a nurse on how often vs should be taken. I am for the above, but the other nurse states that EVERY pt recieve q1hr vs which kills our other pt care activites. And yet I cannot seem to find any guidelines for vs taking.
    Any help would be appreicated.
    MajorDomo
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  2. 14 Comments

  3. by   grammyr
    I just looked at our policy which states that a full set of vitals are to be taken at triage and at least every two hours after that. For the acutely ill, we take them every 15 minutes for at least the first hour, then its kinda up to us. I prefer to take them more often on cardiac, respiratory, etc. For the ones who come in at 2am with a hangnail, I get them at triage and discharge.
  4. by   ClaireMacl
    In our ED, its 1 hour obs for Majors patients, 15 minute for Resus patients and once at triage for minors unless otherwise indicated. Never actually read the rational, I'd be interested to see it though!
  5. by   neneRN
    All pts seen in the main ER (not Fastrac) have VS taken q 2 hours "or more frequently at the discretion of the nurse."
  6. by   MajorDomo
    Thanks for the posts and information so far. I have yet to find any national standards. JCACHO, ENA, and ANA have turned up nada. I found a couple of articles on Medline, but that requires a trip to the University Med Lib. which I was hoping to avoid. Oh Well.
    MajorDomo
  7. by   aquaphoneRN
    In my ED in NYC, it Q4 hours standard, more often for more acute patients depending. There's no real clear protocall at my job, it's very wild-west. You need common sense more than anything. That laceration probably doesn't need vitals Q1 hr. The person getting the blood transfusion certainly does!

    We have no ED techs and usually no nurses aides in my ED.
  8. by   Jen2
    We are supposed to do q 1 hour vitals on all patients and use our discretion for critical patients which I follow the q 5 x's 2, then q 15x's 2, then q 30 x's 2 and so on. It is unrealistic I think to do q i hour vitals on all patients especially psych patients who are not there for a medical problem, but funny enough if we don't have them charted q 1 hour we get called to the office about it in chart review. It would be nice if our aids took vitals, but they don't.
  9. by   Possum
    At my ED in Australia we do Obs at Triage, then 1/2hr on all pts in the Department, except for Recus which is usually 5mins or if stable 1/2hr. For lacerations or broken bones once only. It is really all common sence for the rest of stable pts. However, the CNC can get on our backs if they are not to her liking!!! Even when we are run off our feet short staffed.
  10. by   NYCRN16
    I work in a busy NYC ER, and I am not sure of the protocol, but usually I keep it up to my discretion for critical patients, usually every 15 min or so, not to exceed one hour. Patient in the middle, usually q4 unless they are abnormal on arrival or change in condition, and fast track just at triage. Our managers too get on us if we dont get them frequently, but when you have 13 or more patients, how do you get vitals that often if the PCT's dont do them for you? With peds patients, we get a temp before they leave if CC was fever, and an O2 sat on asthmatics.
  11. by   Possum
    Quote from imagin916
    I work in a busy NYC ER, and I am not sure of the protocol, but usually I keep it up to my discretion for critical patients, usually every 15 min or so, not to exceed one hour. Patient in the middle, usually q4 unless they are abnormal on arrival or change in condition, and fast track just at triage. Our managers too get on us if we dont get them frequently, but when you have 13 or more patients, how do you get vitals that often if the PCT's dont do them for you? With peds patients, we get a temp before they leave if CC was fever, and an O2 sat on asthmatics.
    I am new to this site, do you know what Warn to the left side means please??? What Hospital are u at??? We would never get 13 pts at once!! how can u handle that buy your self!!!
  12. by   NYCRN16
    Quote from Possum
    I am new to this site, do you know what Warn to the left side means please??? What Hospital are u at??? We would never get 13 pts at once!! how can u handle that buy your self!!!

    The average amount of patients we have is at least 5, usually about 8 is average. During the winter it is not uncommon for us to have 10-15 patients each, with us getting a new patient like every 15-30 minutes. We get patients based on rotation, so there is no though given into acuity at all unfortunatly. If you want PM me and Ill name the hospital, dont want to do it on here
  13. by   Possum
    I dont know how to PM!!!
  14. by   NRSKarenRN
    fftopic:

    Quote from Possum
    I am new to this site, do you know what Warn to the left side means please???
    Hi there

    Nothing to worry about - everyone has these - warnings are used for terms of service violations - yours says "0" so you have not received any. Other posters cannot view yours, which is why you can't see theirs.

    Hope this helps!

    NRSKarenRN
    Allnurses Admin Team

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