Can I document respiratory rate if pt refused vital signs?

[Nurse Beth, MSN]

Dear Nurse Beth,

Recently, one of my co-worker pointed out that we keep charting patient refused for temp, O2 sat, pain and RR check. Patient speaks another language, alert oriented x3 and really refuse vital signs to be check. Is it allowed to chart RR? He said I just have to look at the patient. I just feel that I will be violating resident's right to refuse if I do that. VS monitoring is part of the facility protocol. Thanks in advance. 

Dear Violating Resident's Rights,

Since your patient speaks another language, be sure and have it documented using a facility-approved translator that he is refusing to have his vital signs checked.

I can see a resident refusing an O2 sat and temperature, blood pressure, maybe refusing to state their pain level...but how does a resident refuse to have their respirations counted? It seems unlikely that he said this explicitly. 

But even he did specifically indicate not to take his respirations, you can count and document his respiratory rate without much concern. No one is going to successfully sue a facility for counting respirations after having signed a Conditions of Admission. Your manager should guide you on how to manage this situation, and if in doubt, your manager can consult with the Risk department.

It's also for the greater good to document respiratory rate, because it's an indicator of many serious conditions, up to and including sepsis.

Try to have a Social Services consult to maybe involve the family or in some way find out what the real issue is for this resident.

Best wishes,

Nurse Beth