Monitoring Vital Signs

Monitoring vital signs (Temp; HR; RR; BP; SaO2) on the B6 should be based on clinical assessment. It is recommended that while in hospital, patients should have their vital signs assessed 12 hourly unless documented in the clinical notes.

When a patient is admitted acutely, a full set of vital signs with Early Warning Score (EWS) calculation must be carried out every six hours for the first 24 hours of admission. See New Zealand Early Warning Score (NZEWS) on Hospital HealthPathways.

More frequent observations are based on the condition of the patient. If the patient condition changes or they are feeling unwell then vital signs should be taken and the frequency reassessed.

If the patient is febrile and neutropenic then 4 hourly vital sign observations as a minimum should be undertaken. Assessment for hypovolaemia and a decrease in urine output should also be undertaken.

When taking vital signs, assess the trend of the patient. These trends will give you a wider assessment of what is happening to them. This includes the use of the New Zealand Early Warning Score and Policy. Note that one of the first indicators of deterioration in a patient’s condition is a change in their respiratory rate. Note also that there has been a relatively recent change in the scoring system, based on the NEWS (National Early Warning Score from the UK NHS). This well-validated system is better at predicting death, cardiac arrest, or ICU admission than any other published EWS system (Prytherch, Smith, Schmidt, and Fetherstone, 2010). The score is based on 7 parameters:

Changes in vital signs are unique to the individual. Therefore any changes to baseline vital signs warrant closer monitoring.

Reference


About this Canterbury DHB document (7090):
Document Owner:	Sean Macpherson (see Who's Who)
Last Reviewed:	January 2019
Next Review:	January 2022
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Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer The Haematology Department Protocols and Guidelines (the Red Book) are intended as a guide for registered health professionals to communicate guidelines and share best practices with supporting health professionals within New Zealand district health boards. They are not intended to be provided to or used as a reference for patients or non-registered health professionals. All health professionals must exercise their own clinical judgement and use pertinent clinical data when treating patients. The authors and editors of this publication have checked with sources believed to be reliable in their effort to provide information that is complete and in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical science, neither the authors, editors, publisher, nor any other party who has been involved in preparing or publishing this work warrants that the information contained in it is accurate or complete in every respect. They therefore have no liability (whether in tort (including negligence) or otherwise) for any loss or damage arising out of any reliance on this information. This publication has been compiled by the staff and contractors of Canterbury District Health Board (CDHB) and as such CDHB has copyright for this book. Amendments must be authorised in accordance with the documented process. No release of part of, or all of, this publication to any other party or organisation is permissible without the prior approval of the designated document owner.
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