Frequency of observations

madwife2002, BSN, RN · Mar 14, 2008

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.

karenG · Mar 14, 2008

guess it depends where you work- when I worked on an ophthalmic unit, we did obs once on return from theatre then didnt do any more- no idea why not- maybe something to do with the fact we had 3 nurses and a list that was most of the unit- ie 20+ so we just spend the day running backwards and forwards to theatre, and putting eye drops in!

all other places i worked seemed to do quarter hourly obs for 2hrs then drop to hourly for a couple of hours then back to qds once the patient was awake.

but then its been a couple of years since I worked in a hospital!

cariad · Mar 15, 2008

ours are the same as madwife's but no evidence base for it, just hospital protocols, the techs take all the vital signs, and usually just set the machine to take them and then go back and read them and document them, so sometimes no-one is seeing the results straight away anyway.

just have to use our own judgement if the patient is poorly or not.

allnurses Guide · Mar 15, 2008

I have to Echo what Cariad and Madwife has said.

Obviously changes if patient conditions warrents it

RGN1 · Mar 15, 2008

This was what I meant - we're all doing these obs because of un-researched protocols & when our unit just issued us with new giudelines when we're struggling to cope as it is, it got me thinking.

I did some rsearch & have found that there's no link between changes in vitals & post op complications being spotted! I also found out that there's no set protocols because there's no evidence to show what is best so each ward/unit or hospital creates their own based solely on traditions that pre-date our newer, saf er anaesthetics.

Really it should be left to nurses to assess their patients and decide what is best. You can easily drop the number of obs you do now without compromise to your patient as long as they return (as they should) stable from recovery.

The main thing is to keep checking your patient and tally your obs accordingly.

What do you think? Are you surprised? I was! I was also pleased because it gave me some ammunition to fight with!! :-)

Anyhow I'm presenting my findings, with love, next week!! One thing is for sure there's no way any of us are going to be able (or willing) to do the ridiculous amount we have been told to!!

sofaraway04 · Mar 18, 2008

I work on a medical ward. so we only ever have a few surgical patients, I will always do obs as soon as the pateint arrives back on the ward, then 30 minutes for 1 hour, then hourly for a couple of hours and then back to normal 4 hourly.

the only exceptions are pateints who have had angiograms, there is a specific care plan which from memory is every 15 minutes for 1 hour, 30 minutes for 2 hours, hourly for 4 hours then back to 4 hourly, often seems a bit excessive, but i follow the careplan.

we are not allowed to use the dinamap anymore so they all have to be manual obs, so we can't just set the machine and document them at regular intervals. this is where 15 mins obs are a pain.

cariad · Mar 19, 2008

our techs do the vital signs, so its all a lot less stressful. we use machines, but they can do them manually if we need them to.

you will have to look on websites if there has been any research done on the subject. theres always nurses like me doing further uni courses looking for topics to research. so it might have something written on it.

RGN1 · Mar 19, 2008

I work on a medical ward. so we only ever have a few surgical patients, I will always do obs as soon as the pateint arrives back on the ward, then 30 minutes for 1 hour, then hourly for a couple of hours and then back to normal 4 hourly.
the only exceptions are pateints who have had angiograms, there is a specific care plan which from memory is every 15 minutes for 1 hour, 30 minutes for 2 hours, hourly for 4 hours then back to 4 hourly, often seems a bit excessive, but i follow the careplan.
we are not allowed to use the dinamap anymore so they all have to be manual obs, so we can't just set the machine and document them at regular intervals. this is where 15 mins obs are a pain.

It would be interesting to see what research was used to decide on the angiogram obs - especially as the most important thing for them is inspecting the puncture site - as by the time vitals had changed it would be too late (or almost too late!)

The body can compensate for an awful long time & so by the time the obs change they could be in serious trouble! Of course good nurses spot problems way before that & the research I've read so far states that post op complications were found incidental to obs by nurses in ALL cases!! Again I hasten to add we're talking about minor - intermediate planned surgery on generally healthy patients here.

your surgical obs are not too bad - a lot less than we're being asked to do anyhow - we can use dynamaps etc but there aren't enough to go round if you have 5 patient's all needing half hour obs at the same time. Especially when your colleagues also have roughly the same number of post-ops on the go!

No techs for us either - as is usual in the UK - nurse has to do the lot!

It's an interesting topic though because here we all are just following protocols that come from an era where anaesthesia was not as safe as it is now & where surgery was far more radical in many cases e.g open cholecystectomy as opposed to the laparoscopic version done today.

I'm not for one minute suggesting we don't do obs but we should be free to look at each patient individually. If my patient has been stable in recovery & on return to the ward I should be free to choose to take the next obs an hour later, then 2 hours then 4 hours. I don't see why I should continue to take 3 hours worth of half hourly obs when the patient is alert, awake, orientated & sitting up in bed eating!!

ayla2004, ASN, RN · Mar 19, 2008

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

RGN1 · Mar 19, 2008

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, ASN, RN · Mar 19, 2008

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.