PAT I ENT MONI TORING
The importance of vital signs monitoring
A virtual conference dedicated to advancing ‘connected care’ has highlighted the importance of vital signs monitoring to detect deterioration and sepsis. Early detection saves lives and improves outcomes, so how can we improve the current state of care? Louise Frampton reports.
An educational programme, Completing the Picture, recently brought together doctors, nurses and patients as part of an online forum to discuss best practice in detecting and managing deterioration. The panel highlighted key areas for improvement, shared their personal insights and debated the scope for technology in the ICU and beyond. We know that better detection of deterioration leads to better outcomes. But what role can technology have in improving vital signs monitoring and where should the line be drawn to ensure a balance between automating observations and providing the human touch?
Chaired by Catherine Godfrey, editor
of Nursing Times, the virtual conference opened with an insight into the detection of deterioration from the perspective of Karen Nagalingam. An acute kidney injury nurse
specialist at Lister Hospital and senior nurse lecturer at the University of Hertfordshire, she explained that deterioration generally refers to the fact that the patient is no longer able to maintain homeostasis. “Breathing rate is an important clinical
sign, but it is also a difficult parameter to measure. It is vital that we get this right. It is a key indicator that the patient may be deteriorating and becoming unwell. A rise in breathing rate could indicate pain or anxiety, but it may also indicate the body’s attempt to compensate for a deficit of oxygen in the blood. The rise in respiratory rate is what we term ‘compensation’ – an example of this can been in patients with pneumonia. It is this compensation that we see with an escalation of observations and a raised National Early Warning Score (NEWS),” Karen commented. She added that it is the subtle signs that clinical staff sometimes need to look out for
– a change in mood, behaviour, confusion, or more confusion than normal, observed by relatives. “We assess and look for clues that there are problems with the patient – is there any sound from their breathing? Is there any wheeze or rattling? What do they look like? How do we know they are hypoxic, for example? What is the colour of their skin? What is the temperature of their skin: is it cold or hot?” she commented. “We can use a systematic approach to detecting deterioration: ‘ABCDE’ (Airway, Breathing, Circulation, Disability and Exposure). We start with the life-threatening areas – ABC – which is part of our resus training; then disability (D) and exposure (E). This gives us a process and a plan for how we should act and assess the individual,” Karen continued.
Over the past 10 years, hospitals have seen development and implementation of early warning scores. Most Trusts have implemented the Royal College of Physician’s early warning score – NEWS or NEWS2 (the latest version) – which advocates a system to standardise the assessment and response to acute illness. However, there are multiple different early warning scores currently available. “These are really important as they not only provide a guide to escalation, but also the actions required to respond to raised scores. NEWS also enables staff to think about trends. Everyone is different – for some people a pulse rate of 50 will be normal, while for others it may be over 100. It looks at the change that is specific to the individual,” commented Karen. She went on to highlight the opportunity
for e-observations, which are rapidly being adopted across Trusts, and the importance for specialist teams – such as sepsis teams and critical care outreach teams, who support staff in making decisions over the
MARCH 2021
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