Frequency of Vital signs/Assessments

[moonshadeau, ADN, BSN, MSN, RN, APN, NP, CNS]

Hello all,

I am reviewing the policies/standards for our ICU and am having difficulty finding literature to support how often a patient should be assessed and have vitals recorded. Now obviously the really sick ones are more frequently. I am wondering about the average ICU patient and the minimum that every one does an assessment on.

Thanks.

[TennRN2004]

Total body assessments are done every 4 hours, minimum, but can and should be done more frequently if warranted by changes in pts status. Vitals are: temps every 4 hours minimum (but if we have criticore, most of us document every hour temps) bp, hr, and rr every hour. We chart bp every 15 if actively titrating any type of gtt. These are the standard expectations on assessments for all 3 of our ICUs (medical, coronary, and surgical with OHS pts). Some subsets of pts, such as the cardiac sugery pts, have specific order sets requiring specific assessments every hour until the am.

[moonshadeau, ADN, BSN, MSN, RN, APN, NP, CNS]

Thanks TENNRN,

This is also what we do. But according to policy, we only have to check every 8 hours CV, pulmonary every 4. So I am updating the policy to reflect our practice. We usually do every 4 hour complete assesments, and document all vital signs every hour, including gtts.

[christianRN]

head-to-toe assessment every 4 hours (or more often if needed)

rr, hr, bp q1h, more often if titrating drips

temp q4h or more often if needed

[dorimar, BSN, RN]

Head to toe assessment Q4 H. System specific assessment Q2 H. VS Q1 H and more often if titrating drips or unstable. Temp is only Q4 H unless issues with temp. I&O Q1 H. dly wt.