Canterbury DHB

Context

Monitoring Vital Signs

Monitoring vital signs (Temp; HR; RR; BP; SaO2) on the BMTU 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 hospital-wide CDHB Early Warning Scores and Policy.

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.

According to CDHB policy, patients with an EWS of 8-9 (Red Zone) require registrar review within 20 minutes, increased frequency of observations (minimum of every 30 minutes) and consideration for ICU referral if not improving. Patients with an EWS score of ≥10 (Blue Zone) should be referred immediately to ICU outreach. This can be done by any health professional.

For more information, see Intensive Care Requests on Hospital HealthPathways.

NZEWS

CDHB NZEWS

About this Canterbury DHB document (7090):

Document Owner:

Sean Macpherson (see Who's Who)

Issue Date:

January 2019

Next Review:

January 2022

Keywords:

Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer

Topic Code: 7090