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Should patients be woken up to monitor vital signs?

  • Comments (9)

Should patients requiring vital signs monitoring every four hours be woken at 2am to have their observations recorded? What do you think?

Expert comment

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.

  • Comments (9)

Readers' comments (9)

  • You know what, I was debating this myself not so long back with a few colleagues, not just about obs, but for other tasks such as PAC and so on.

    I thought then, as I do now, that many of these tasks were being carried out unneccassarily because they were routine and fit in with the '2 hourly' or '4 hourly' rule, whatever is being used at the time, regardless of the disturbance to the patient.

    Now don't get me wrong, if your own clinical judgement dictates that the need for the task outweighs the disturbance to the patient, then that is absolutely the right thing to do (especially if you can get away with doing it without disturbing the patient as outlined above). However, the tasks should not be done simply because of the routine. There should be a lot more flexibility in this area I think, and a lot more focus put on Nurses judgement.

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  • Anonymous

    the problem is that patients are put on routine obs and it sometimes happens, especially if the ward is very busy, that they forget to take them off when they are no longer necessary. this can cause a dilemma for the nurse who is on night duty.

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  • Anonymous | 2-Aug-2011 5:51 pm Not neccessarily, that is my point. If the Nurse on night duty comes on and the patients condition still demands that 4 hourly obs are needed, then by all means conduct them, or more if their condition deteriorates. But if the patients condition improves, then what is stopping the Nurse from taking them off regular obs themselves? Making that judgement call that their condition has improved enough that they would benefit more from sleep than continuing with a routine regardless?

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  • Anonymous

    We have this ridiculous computerised system for recording obs (and more and more stuff is being put on it-it's getting ridiculous). The systems is not even that good. I had one patient with malena, all obs were fine bar the BP, which had dropped from perfectly normal to about 80 systolic in 2 hours but because he only had a EWS of 3 (I think) the system thought he was OK and needed 6hrly obs-I did them much more often than that. The Reg ended up having to get the gastro consultant on call in and he was scoped in theatre. We're not allowed to let the obs time out on it. It's stupid, pt's have to be woken in the night to have their obs taken even if they're stable otherwise the sister in charge nags about it. I've had arguments with the ward manager about it. If I was in hospital, and was quite well, and was woken in the middle of the night for my obs to be taken, I would not be happy.

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  • Anonymous

    Agree obs should not be done overnight if patients clinically stable. Sleep is more important. Nurses should be walking around checking on patients whilst asleep to ensure they are ok and if the feel there is a problem then take action. Also obs being done at 6am as routine is stressful for patients as they are woken early, especially those that only have obs done once a day. Let patients sleep there is enough noise in hospitals to disturd them without nurses adding to the burden.

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  • There is probably a huge evidence-base I have not consulted.
    But personally, I am pretty certain that my heart-rate slows quite a bit when sleep, and I suspect my blood pressure drops. If you were to wake me up, I would be in an atypical 'startled' condition - then, perhaps in an 'annoyed' condition.
    So the interpretation of some of these obs, interests me !

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  • Anonymous

    Sleep is important, but I appreciate obs should carried out where necessary. However, it's the other things that keep patients awake that need to be addressed: I saw lady in primary care the other day, recently discharged from secondary care. She said the biggest relief was to finally get some sleep at home: she said they were emptying the bins on the ward at midnight. Another patient admitted to a Medical Assessment Unit late at night was finally clerked and allowed to settle to some sleep, only to be woken at 2 hrs later for a weight: surely some things can wait to a more appropriate hour...?

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  • Anonymous

    waking a sick patient in the night to weigh them is beyond all common sense and comprehension!

    our hospital cleaners came round at four in the morning riding up and down the corridors sitting on two large and very noisy industrial machines washing with a solution of soapy disinfectant making the floors very wet and then drying and polishing them. This also involved shouting at each other to communicate! (incidentally the patients' rooms were spared and then disinfected periodically during the day when the whole room had to be emptied and then left to dry for a couple of hours but we got prior warning as we had to move all the patients and furniture!). During the day the ward cleaners cleaned thoroughly everywhere and the HCAs went round again damp dusting all floors and surfaces in the afternoon.

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  • I'd like to see a study done across hospitals/trusts on RCAs. Did the Root Cause drill down to the absence of obs at 2 am at any point over x years?
    At our hospital, there's been a suggestion to put off the 2 am obs if you are collecting 4am blood.
    I like Nadine's practice of watching resps, signs of fever, poor perfusion, etc, but how do we get around the need to identify the patient by having them state our 2 hospital identifiers?

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