Significance of Observations rounds in UK??

[Cinquefoil]

Hello, a nursing student from the USA here.

We're looking into Releasing Time to Care, and are being asked to imagine how the modules would relate to the US's health care system, since the hospital we practice at is implementing this Programme. They need the modules adapted, and we're a low-cost problem-solving measure. :)

My working group was assigned the "Observations" module, and we're a little stumped as to what, exactly, Observations might be. We see that they include vital signs and a fairly basic list of questions into the patient's experience and well-being. But it's taken for granted that we'll know how often they're done and how they're used to further the patients' care.

Here in my part of the US, a more common ward (=unit) policy is:

• A full physical assessment done and charted per shift/ every 8 hours/ every 4 hours (depending on institution and unit policy)
  

• Vital signs done and charted every 4 hours to 8 hours in general, and at times as often as every 15 minutes if the patient has just gotten back from a major medical procedure like cardiac catheterization or surgery.
  

• Additional vital signs as needed, according to the judgement of nurses, doctors, and aides
  

• Additional focused assessments as needed
  

• Rounding (= visiting 2-8 patient rooms) every 1-2 hours by every individual nurse. The nurse will only be expected to round on the patients they're assigned to, unless they get asked to temporarily take on another nurse's patients while the other nurse eats lunch or does something urgent. During rounding, it is expected we will ask all questions about pain, comfort, etc.
  

• Call lights - patients are provided with buttons they can press to call anyone at need. Anyone who sees a call light flashing in the hallway outside the room is expected to answer it, though in practice some nurses will hurry faster if it's "their patient", while others may not hurry and may expect an aide to answer the call light for them.
  

• Everything charted
  

Baths, oral hygiene, vital signs, weights, ambulation, and toileting are generally left to the aides to do. The nurse is responsible for all other tasks for their 2 (in the ICU) to 8 or more (in med-surg...if they're unlucky) patients.

How is this similar to, or different from, the patient assessment practices run by the NHS?

And where do Observations fit in with this picture?

Any help greatly appreciated.

Sincerely,

Cinquefoil

[XB9S, BSN, MSN, EdD, RN, APN]

Your talking about intentional rounding I think, which should be hourly. Our registered nurses will perform much of the basic care with the assistance of health care support workers.

There's a bit of an explanation in this link.

A commitment to quality

Will hourly rounds help nurses to concentrate more on caring? - The King's Fund

'Display outcome data on wards to boost care and motivate staff'

[Cinquefoil]

Thank you, XB9S. I did look up all your links right away though I didn't write back so soon.

They were helpful because some of our module does seem to concentrate on rounding.

After a great deal of brain wringing on the part of myself and my classmates, we think it's talking about a combination of rounding and taking Obs to fit into the Early Warning System (which we don't use in the USA). There is a Releasing Time to Care module on rounding, but since ours was so specific to vital signs and a vague-but-clearly-specific-to-the-UK system for escalation, we were stumped.

Now we're just stumped as to how to fit the module to US hospitals. We DO escalate when vital signs shift, but so far it seems that it's generally per judgment and not as much per protocol. But maybe that's one of the things that Releasing Time to Care can help us change?

[XB9S, BSN, MSN, EdD, RN, APN]

EMERMED : Emergency Medicine Journal

http://www.nice.org.uk/nicemedia/pdf/CG50FullGuidance.pdf

Early warning scores: effective use

Validation of a modified Early Warning Score in medical admissions

1000 Lives Plus (archived) News - All-Wales illness response system showcased to rest of UK

I'm sure you've already got the information but here are a few links to the benefits if EWS / MEWS/NEWS scoring systems.

[Cinquefoil]

Information = :redpinkhe