Manual observation push to prevent deterioration
Nurses across the country are returning to manual observations following evidence that reducing reliance on technology can dramatically improve care, Nursing Times has learnt.
Trusts are abandoning or planning to reduce their use of automated machines that take blood pressure readings, amid fears that they make it more difficult to monitor vital signs.
They are following in the steps of Salford Royal Foundation Trust, which reduced cardiac arrests by 32 per cent after launching a scheme involving a return to manual blood pressure readings (Click here to see the Nursing Times article).
At Medway Foundation Trust, critical care consultant nurse Catherine Plowright is planning to replace automated machines in a surgical ward with traditional sphygmomanometers for a trial period this summer.
“Standing with the patient and talking to them may well be the thing that makes the difference in picking up vital signs,” she said.
She said the move had attracted “mixed responses” from clinical staff. But monthly observation audits will reveal whether it has helped staff detect signs that patients’ conditions are deteriorating at an earlier stage.
George Elliot Hospital Trust is introducing a system in the next three months whblood ereby all blood pressure readings taken with automated machines will then be checked against manual readings.
Director of nursing, quality and workforce Dawn Wardell said: “We’re using much more machinery now. There’s a whole piece of work that needs to be done to show us whether we should keep [technology] across the board.”
Many nurses were discussing similar moves at their organisations at Nursing Times’ and HSJ’s Patient Safety Congress last week.
She hopes to gather evidence as to whether the two techniques produce different results.
A Nursing Times survey last year found 85 per cent of respondents used automated technology to monitor vital signs. But 42 per cent felt reliance on this equipment could make nurses less likely to identify, or act on, signs of patient deterioration.
Patient observation and the deteriorating patient is one of the central elements of a National Patient Safety Agency drive to increase engagement with nurses.
NPSA head of patient safety (deterioration) Kate Beaumont said there needed to be a debate as to whether there should be a wholesale return to manual observations, particularly for blood pressure readings.
She said: “It seems to be more accurate when someone has an abnormal blood pressure, particularly when it’s low.
“But more importantly, it encourages and promotes an improved patient assessment by nurses because it encourages nurses to touch, feel and press.
“You can feel whether someone’s clammy, or hot, or cold. It promotes that compassionate relationship between the nurse and patient because you spend more time with them and talk to them.
“By using a Dynamap, my hunch is that you spend less time on observations.”
North Tees and Hartlepool Foundation Trust executive director of nursing and patient safety Sue Smith said she was “very interested” in phasing in manual observations for blood pressure readings across “most areas” of the organisation.
This is because it would improve monitoring of vital signs and prevent technology from “deskilling” nurses.
However, it may not be practical for patients requiring very frequent observations, she added.
Walsalls Hospital Trust resuscitation officer and clinical skills lead Phil Jevon has published a comparison of different blood pressure measurements that found the mercury sphygmomanometer was still the “gold standard”.
He said it was important for nurses to understand the limitations of automated devices, particularly for critically ill patients. They could be inaccurate if wrongly calibrated or in certain circumstances such as cardiac arrhythmia. However, there was insufficient evidence to support a universal “back to basics” approach.
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