Should patients requiring vital signs monitoring every four hours be woken at 2am to have their observations recorded? What do you think?
Recording patient observations is an important part of nursing routine and an essential skill to be able to detect changes in the patient’s condition. A “one-off” or isolated observation is of little use unless compared to recent trends in clinical status. If a nurse is concerned about a patient enough to be motivated to carry out four hourly observations then that patient should be woken to have those observations recorded. However, nurses should also feel empowered and confident enough to be able to adapt their routine to reflect a patient’s progression towards recovery.
Sleep is an important component of patient recovery and one of the most essential activities of daily living. Sleep deprivation is associated with delirium, which in turn has a negative effect on patient rehabilitation. This leads to increased length of stay in hospital, which corresponds with increased cost and, most importantly, is unpleasant for the patient. Nurses should be able to carry out an “end of bed” observation without waking a sleeping patient. That is, be able to assess whether the patient has a patent airway, observe respiratory pattern and count the respiratory rate and be able to detect whether the patient is well perfused and, therefore, whether the patient has a adequate cardiac output. Nurses should also trust their instinct and if they feel the patient is deteriorating the question they should ask themselves should be whether four hourly observation is enough or should the patient be monitored more regularly or even continuously. At this point medical or critical care intervention should be sought.
David Jones, Charge Nurse, Critical Care.