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Learning Objective 1: describe the evidence based for frequent vital signs of postoperative adults
Learning Objective 2: analyze the effectivenss of Unit Based initiative to reframe nursing practice
The surgical unit nursing staff of a Magnet designated community hospital expressed frustration with the postoperative assessment policy requiring every 15 minute vital signs for the first hour, and hourly vitals signs for the next 4 hours. When a review of evidence based literature was unable to inform practice, the Unit Based Practice committee conducted a retrospective review of 119 randomly selected postoperative patient records. Records of adult patients that received general anesthesia without epidural analgesia were included. Analysis indicated no clinically significant change in mean heart rate or blood pressure during the first 2 hours, or 6 vital sign assessments, after admission to the postoperative surgical unit. The findings were disseminated to the appropriate interdisciplinary committees for consideration. A new protocol, requiring vital signs hourly for two hours, then every fours hours, was implemented. Nursing judgment became the determinant of more frequent vital signs. A follow up retrospective review, recently completed one year after the policy change, applied the same methodology as the original study. While the sample mean age for the follow-up study was older (53 years vs. 58 years) there was also no significant change in mean heart rate or blood pressure during the first 2 postoperative hours in the 93 records reviewed. None of the patients on the new protocol required emergency intervention by the Rapid Response Team.
The data validated the revised policy on vital signs supporting nursing judgment in the assessment of postoperative patients. An individualized assessment of postoperative patients allows for more efficient use of hospital resources, improved patient care and nurse satisfaction.
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