Cluster Care & Vital Sign Frequency

[NurseOfTheLittlePeople, BSN, RN]

Hey there, fellow NICU nurses!

I've been working in a very large, level IV NICU for nearly three years. When it comes to cluster care and vital signs, I have questions about how my hospital operates in comparison with other hospitals.

Our vital signs tend to be Q4h for higher acuity babies and micropreemies and then eventually Q6h as they grow older. Feeder growers are commonly Q6h, but our tiny 23 weekers are always Q4h. However, despite how Q4h is the prescribed vital sign frequency, this is generally only adhered to when a baby is NPO. When a baby receives Q3h feeds, many nurses grab a set of vitals and change the baby's diaper anyway, since they're already touching baby for abdominal assessments before feeding. I understand clustering care is extremely important for neonate development and that uninterrupted rest improves brain growth and I'm conflicted here. Touching a micropreemie 8 times a day seems unnecessary, especially if they have temperature probes, arterial lines, IVs and other monitoring equipment that wouldn't require Q3 peripheral BPs and axillary temps.

How do other NICUs handle this dilemma? Is it even a dilemma in other places?

Thank you ahead of time for your input!

[NICU Guy, BSN, RN]

Patients that are fed Q3: Full assessment/ temp/diaper change/ feed on a 9/3 schedule. At 12/6 feeds, we do temp/diaper change/feed.

NPO/Continuous feed: Full assessment/temp/diaper change/feed Q4 8/12/4. Vitals off the monitor at 10/2.

High Acuity patient:Full assessment/temp/diaper change/feed Q4 (8/12/4) and vitals off monitor every hour when not doing a full assessment.

Ad Lib Feeders: Full assessment/temp/diaper change/feed, usually Q4-Q5 (maximum) whenever baby is hungry.

[TiffyRN, BSN, PhD]

Feeders (what I do most):

BP once a shift unless on anti-HTN meds.

Temps Q3 if eating, can be stretched out further if they kid is ad lib and eats less frequently. For those more stable older kids we aren't likely to wake them up just for a temp unless we're worried about the temp. I've gone up to 6 hours and no one blinked an eye (hourly vitals recorded from the monitor).

Sats every hour unless (in rare cases) the pulse ox has been DC'D

Only required to record RR/HR every 3 but since our monitors feed into our EMR, most people record this hourly since it's an easy mouse click.

Sicker kids usually get q4 temps unless min/stim, then less frequently. BPs twice a shift if the kid is on IVF above KVO. Kids on continuous feeds usually only get hands on cares Q4h. Like I mentioned earlier, we tend to record hourly HR/RR even on feeders since it feeds directly into the EMR. If they have an art line of any kind, at least hourly BPs. Probably a lot more details about the sicker/smaller kids but I don't generally work with them.