[RGN1]

Originally Posted by ayla2004

on the day surgery ward in my trust if a patient has had a short procedure 20-30 mins and has been in recovery for 30mins and is not returned until stable and usually awake they did on set of obs and then on clinical need if they didn't need them they didn't do them.
only the patient in for pain block that only had locals had a obs regime.
our liver biopsy patients its every 15m for one hour.
we where told in uni that frequency of obs has little to do with outcome and that the patient suffered post op due to a ward thinking his procedure was low risk and had had stable obs, not in a observatable bed but bleed out via the entry site. the point was nothing minor everything has risk and all patients needs observed.
oh and respiration rate is a better indicated of declining so some reserach shows

Well this just goes to prove that there's no logic as well as no proper research as to what obs to do!

I'm not for one minute suggesting we don't do obs but that the nurse should be allowed to treat each patient as an individual and document his/her care as is appropriate to the condition of that patient.

It comes to something when patient's having LA have a regime but those having GA don't!

Also pick up the point that a bleed is more likely to be seen before the obs actually change & that once it's got to the point where the obs have changed that patient is in serious trouble!

It is well documented that resps & pulse are early indicators of problems & I'm trying to work on that for our higher care patients so that they don't get woken up every half hour for 10 hours for their BP to be measured! My argument is that as they are constantly monitored on a 1:1 basis so we can document their resps & pulse but omit the BP for longer periods if the former are stable.

Our time would be better spent actually looking at our patients than going in & taking readings then flying out to the next one & the next one & the next one because we have to do obs every half hour on everyone because that's what protocol states. As you said frequency of obs has little correlation with patient outcome & that's my argument. If we have less frequent clinical obs on stable patients we can actually spend more time looking at our patients holistically.

[ayla2004]

the LA's didn't go to recovery
can the nurses where you work get to do obs at the current regiem i;ve found that every 15 r 30 isn't actually such in real life and thats while i've been the student, on a ward without those extra sets of hands it must be harder.
my trust has brouht is a policy were full sets of obs have to be done for EWS whereas at night most wards on non-post op patients only did sats and heart rate and so as not to wake patients.

[RGN1]

Originally Posted by ayla2004

the LA's didn't go to recovery
can the nurses where you work get to do obs at the current regiem i;ve found that every 15 r 30 isn't actually such in real life and thats while i've been the student, on a ward without those extra sets of hands it must be harder.
my trust has brouht is a policy were full sets of obs have to be done for EWS whereas at night most wards on non-post op patients only did sats and heart rate and so as not to wake patients.

This is on the ward not recovery, just to clarify.

It's because the regime being requested is just not possible that I'm interested finding out what goes on else where & if anyone has any quantitive research to back up their current practice. I know corners will be cut, maybe obs will be falsified (we all know it happens) & really important things will be missed because we're rushing around with our dynamaps trying to chart uneccessary obs.

I have become much more interested since I started looking in to it because the research that has been done (& it's not much) has actually found that frequency of obs has no correlation to the finding of complications in post op patients.

In this era of evidence based nursing & research based practice (hahaha) I just think it's time nurses were allowed to nurse again. I'm fed up of non-nurses telling me what I should do without backing it up with any research whatsoever.

[ayla2004]

the trusts are so scared of getting sued, death of injury due to medical/nursing care and protocols called into question.
i can say as a 1st student on a ENT ward i was taking obs and in a sense i had to learn how to intreput, by frequently checking with RN, they are just numbers and not a way of assesing conditions. if hca or st/n are taking the obs the figures are only as good as the ability to asses and that is why EWS i think has come in. EWS has helped me in A&E a raised EWS score made me alert medical staff to check him after i asked my mentor. however recently i was doing progess and evalution on a pt that a 1st year st/n had taken the obs, pt had raised resp low bp all charted, scoring ews=3(medics to be informed) but no action taken and the 1st year didn't know these were things you act on. pt got volume expanders and follow up fluid was on iv abx.
i know you are not talking about st/n

[RGN1]

I know what you're saying but causing nurses to effectively spend even less time truly assessing their patients is actually going to cause more problems in the long run. I'm not talking about no obs though, just sensible amounts.

For your interest I have had cause to send a patient who "only had a gastroscopy" to the Coronary Care Unit because she developed chest pain & it turned out she'd was having an MI!

I want to add that patient was in recovery at the time, they had supposedly been doing obs but were in a hurry to get her back to the ward. they tried to persuade me her chest pain was related to gas used in the procedure - well I know that they don't do that in gastroscopies only colonoscopies! Her obs were all charted as stable but when I insisted on them putting her back on the monitor (which they are supposed to be on in recovery) her heart rate was over 200 & she was throwing off ectopics!! Where all the multitude of charted stable obs came from I don't know!!

That's why I think that a more sensible regime that allows time to properly assess the actual state of the patient is better than hundreds of obs where no-one's actually looking!

I was concerned the minute I walked into recovery, just looking at the patient. The recovery nurses were looking at their machines & writing down whatever without thinking. They were taking obs every 5 mins but failed to spot the start of an MI!! Maybe if they were only taking them every 15 mins they'd have had a chance to actually look properly at their patient instead??

[Sueilp]

Originally Posted by madwife2002

We do vitals every 15 mins for one hour, 1/2hourly for 1 hour and then hourly for one hour. Depends on the condition of patient of course.

We do the exact same thing too!!!