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Observations and monitoring: routine practices on the ward

Alison Oliver1, Colin Powell, Dawn Edwards

  • 1University Hospital for Wales, Cardiff.

Paediatric Nursing
|May 28, 2010
PubMed

Insights

Routine pediatric observations are inconsistently recorded, hindering the implementation of early warning scores for critically ill children. Improving data collection is crucial for patient safety and effective critical care systems.

Area of Science:

  • Pediatric critical care medicine
  • Clinical nursing practice
  • Patient safety monitoring

Background:

  • Effective monitoring of physiological parameters is essential for early detection of critical illness in children.
  • Current routine observation practices in pediatric wards may not consistently capture all necessary data points.
  • Implementing early warning scores (EWS) requires reliable and complete physiological data.

Purpose of the Study:

  • To evaluate the routine recording of physiological observations in pediatric hospital admissions.
  • To assess the feasibility of implementing an early warning score system for critically ill children.
  • To identify gaps in current observational data collection.

Main Methods:

  • Review of routine physiological observations (temperature, heart rate, respiratory rate, blood pressure, oxygen saturation, AVPU, clinical concern) recorded by nursing staff.
  • Data collection from 1,000 pediatric patients, encompassing 9,075 sets of observations.
  • Analysis of the completeness of observation sets required for the Cardiff and Vale Paediatric Early Warning System.

Main Results:

  • Temperature (88.4%), heart rate (86.8%), and respiratory rate (79.7%) were most frequently recorded.
  • Level of consciousness (AVPU) was recorded in 36.4% and blood pressure in 25.1% of observations.
  • Complete observation sets for EWS triggering were obtained in only 52.7% of patients.

Conclusions:

  • Significant variations exist in the frequency, type, and completeness of recorded pediatric observations.
  • Inconsistent data collection poses a barrier to the successful implementation of pediatric early warning scores.
  • Current practices indicate that essential observations for acutely ill children are not consistently performed.
Abstract

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