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Study to investigate best timing of patient monitoring by hospital nurses

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How often nurses should check patients’ blood pressure, temperature, respiration rate and other indicators of health is to be examined by UK researchers as part of a new study.

The research aims to identify the ideal frequency of observations for keeping patients safe while avoiding unnecessary extra work for busy staff.

“We aim to provide the first evidence-based protocol for patient monitoring”

Jim Briggs

The study, which has just started, is being led by the University of Portsmouth and funded by the National Institute for Health Research.

It is also being carried out in collaboration with the universities of Oxford and Southampton, Portsmouth Hospitals NHS Trust and Oxford University Hospitals NHS Foundation Trust.

The project focuses on the use of the National Early Warning Score (NEWS), the system in place at most UK hospitals to spot signs of deterioration among patients.

NEWS consists of the “vital sign” measurements of pulse, respiration rate, blood pressure, temperature, oxygen saturation and alertness and recommends that all patients should be checked at least twice a day. Patients who are more unwell may need checking more frequently.

However, checking too often can be annoying for patients and interfere with rest and sleep which are important to recovery, noted those behind the new study.

“Nurses in our hospital take patients’ observation over one million times a year”

Paul Schmidt

Currently, there was no evidence to suggest how long the time between observations should be, said the researchers.

They highlighted that nurses also needed to plan their time well to look after patients who needed care. The project aims to identify the correct balance.

It will use vital signs observation data from general wards at two hospitals, which use electronic systems to record the data and calculate an early warning score.

Lead investigator Professor Jim Briggs, director of the Centre for Healthcare Modelling and Informatics at Portsmouth, said: “We know that early warning scores identify patients suffering clinically important deterioration in their condition, and the NEWS used in the NHS has been well validated.

“However, there has been no work about how often the measurements that underpin NEWS should be undertaken,” said Professor Briggs.

He said: “We want to see if we can answer the question: ‘how often should vital signs be taken?’ Some observations could be unnecessary or too far apart to be useful in spotting deterioration.

He added: “We aim to provide the first evidence-based protocol for patient monitoring, which will be both safe and achievable across all acute NHS hospitals.”

Peter Griffiths

Peter Griffiths

Peter Griffiths

Co-investigator Professor Peter Griffiths, from the University of Southampton, said: “An important part of nurses’ work in hospitals is monitoring patients’ condition in order to spot when patients are getting unwell.

“Despite how crucial the work is, decisions about how often to take these vital signs observations have, until now, largely been an evidence-free zone,” he noted.

Dr Paul Schmidt, consultant physician at Portsmouth Hospitals NHS Trust and one of the clinicians involved in the project, added: “Nurses in our hospital take patients’ observation over one million times a year.

“That requires a lot of precious nursing time and effort,” he said. “We would like to ensure all that effort is necessary and used wisely to keep patients as safe as possible.”

The study started on 1 October and will run for 30 months to the end of March 2021.

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