July 3, 2013

JAMA: Why nurses should stop performing overnight vitals checks

Daily Briefing

Eliminating overnight vital-sign checks for low-risk patients might help them heal more quickly and have a better experience in the hospital, according to a study published this week in JAMA Internal Medicine.

For the study, University of Chicago researchers examined data on more than 54,000 patients using an early-warning rating system usually used to determine which patients would be at greater risk of a health emergency. They used each patient's score to determine whether he or she was likely to require overnight care.

They found that about 45% of hospital patients regularly awakened for check-ups overnight were in the lowest risk group.

"Given what we know about sleep disruptions and how detrimental they are to actual clinical outcomes, we would hypothesize that decreased sleep interruptions in this low-risk patient population would improve outcomes," lead author Dana Edelson told HealthDay.

She noted that hospitals have been checking vitals every four hours since 1893. "Everybody is reflexively getting woken up twice a night for vital signs, regardless of how high-risk they are," Edelson said.

Edelson urged hospitals to use the early-warning rating system to identify patients who could forgo overnight vitals checks. "It definitely would require a cultural change, there's no question about that," Edelson said, adding, "we have much more data available to us now than before, and using that data to figure out how to best allocate our resources makes a lot of sense to me."

AHA: Get patients on board

According to Nancy Foster, the American Hospital Association's (AHA) vice president for quality and patient safety policy, such changes would be "challenging but not impossible."

To implement a new system, hospital officials should ensure first that staff understands the data and that physicians can explain the new process clearly to patients. "You don't want [patients] to think you're neglecting them now," Foster said.

She praised the study as an "important piece of work" that "represents data-driven answers to questions about what services that we've traditionally provided." Moreover, freeing up nurses' time from checking on low-risk patients overnight could "be incredibly valuable" and allow them to focus their "attention on patients who are critically ill or in crisis" (Thompson, HealthDay, 7/1; Nurse News, 7/1).

More from today's Daily Briefing
  1. Current ArticleJAMA: Why nurses should stop performing overnight vitals checks

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