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'Why is respiratory rate so often ignored?'

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Respiratory rate (RR) is a vital sign and even a change of as little as three to five breathes a minute can be an early indication of deterioration.

Yet respiratory rate is the poor relation of blood pressure, pulse and temperature in routine observations, and it is frequently omitted or – more worryingly – estimated.

“The reasons for this lack of engagement with respiratory rate are complex”

A respiratory nurse recently told me that she is always suspicious when she sees patients with RR of 18 breaths recorded consistently throughout their stay and is even more concerned when a bay of patients are all apparently breathing at the same rate.

The reasons for this lack of engagement with respiratory rate are complex. There is clearly a lack of knowledge about the crucial role of respiratory rate in detecting deterioration at an early stage, but lack of time and automation may also be factors.

In a recent discussion on Twitter, a nurse pointed out that recording respiratory rate for a full minute would add half an hour to each observation round on a ward of 30 patients. However, if lack of time is a reason for failing to record a vital sign, surely this should be escalated as a safety concern?

This year we have published a six-part sponsored series looking at respiratory monitoring and part 1 – included in this archive issue – explains clearly why RR needs to be prioritised. The series goes onto describe the procedure for respiratory rate measurement and provides a summary of the underpinning anatomy and physiology.

It is a great resource to update your knowledge and educate your team – including healthcare support workers who often carry out this vital observation. The series is also open access and therefore available to non-subscribers.

The second article in this archive issue looks at the anatomy and physiology of the cardiac system. The heart is often described as a pump, but this simple description masks the complexity of this vital organ.

“Most nurses, whether in hospital or the community, meet patients with this condition”

Nurses need to know how the heart works so they can understand the implications for their patients when something goes wrong. This article is part of our Systems of Life series, which helps you to apply anatomy and physiology to your practice.

In England, around 900,000 people have heart failure and this number will rise as the UK population ages. Most nurses, whether in hospital or the community, meet patients with this condition and the third article in this archive issue provides a comprehensive overview of the pathophysiology, aetiology and clinical presentation of this long-term condition.

It is the first of a three-part series that goes on to look at the link between frailty and heart failure and how patients presenting with both conditions have a poorer prognosis.

Visit our Cardiovascular clinical zone to find out more about this important subject. It is one of 50 clinical zones that collate articles from our archive into clinical subjects or roles and settings, enabling you to keep up with your area of interest.

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