Friday, 26 July 2019: 11:20 AM
In Fall 2018, the nursing staff council at an urban magnet hospital began questioning why postoperative vital signs were done at the current frequency. An evidence-based practice project was started to investigate this topic. Staff nurses and Council members did a review of the literature with assistance from the Council’s Co-Chair and CNS (Clinical Nurse Specialist). In a study by Stiver et al., (2017) they found that reduced overnight vital signs monitoring was linked to safety and patient’s perception of sleep quality. In a study by Cardona-Morrell et al., (2016) the researchers found that the selection of “vital signs rely on nurses’ clinical judgement or time availability rather than policy” (p. 9). In a study by Downey et al., (2018) the researchers found that “continuous vital signs monitoring outside the critical care area is feasible and may improve patient outcomes” (p. 19). In a study by Burchill et al., (2015) the researchers found that tradition and ritual rather than research continue to drive postoperative vital sign assessment practices” (p. 249). Following the review of the current evidence in the literature, an anonymous electronic survey on vital signs perceptions was developed using survey monkey and sent to numerous medical surgical and telemetry units at this hospital and also to comparable units at another hospital in the system. The survey participants ranged in age from 20 to greater than 60. The survey participant’s years of experience ranged from less than one year to greater than 35 years. The educational level of the survey participants ranged from diploma to masters degree. Results of the survey showed that the most common postoperative vital signs included temperature, pulse, blood pressure, respiratory rate and pulse oximeter reading. The most common frequency of postoperative vital signs was vital signs every 30 minutes times 2, followed by one hour times 2, and then every four hours. When asked about the top three assessments completed during vital signs assessment the survey participants identified the following as the top three: 1) level of consciousness; 2) respiratory assessment; and 3) surgical site evaluation. The survey also asked what patient factor would compel you to repeat the vital signs on your patient and the top three were as follows: 1) Change in mental status; 2) dyspnea; and 3) prior abnormal vital signs. The survey also asked what clinician factor would compel you to repeat the vital signs and the top three were as follows: 1) clinical judgement; 2) patient acuity; and 3) physician order. Finally as for perceptions on vital signs the majority of survey participants thought the following: 1) the vital sign routine is evidence-based; 2) frequency of vital signs should be individualized; 3) they feel overwhelmed trying to complete the different frequencies of vital signs; 4) postoperative vital signs are an accurate reflection of the patient’s condition; and 5) repeating vital signs regularly is beneficial for the nurse and institution in case of a law suit. Future plans for the next project include collaboration with primary service surgeons to further investigate the variations of the “per unit protocol” order for vital signs frequency in the electronic physician orders among multiple hospital units.