Physiological Observations and Nursing Interventions in the Pre-Arrest Patient: A Descriptive Study

Aim: To identify how nurses respond to abnormal physiological observations in the 12 hours prior to a patient having a cardiac arrest. Methods: A descriptive observational design was used to retrospectively review the observation charts and nursing notes of 28 patients who had an in-hospital cardiac arrest, during a 20 month period. This study was performed in a large, tertiary teaching hospital in New Zealand. Key Findings Only one patient met the hospitals minimum standard of four hourly observations and a full set of vital signs were performed on only three patients. The nursing responses were limited to increasing the frequency of observations or informing the doctor. There were few other interventions to treat the abnormality. Eight (32%) patients who had either no response or a partial response to their abnormal physiology did not survive. The nursing documentation demonstrated that abnormal neurological observations were tolerated for significant periods of time and were not acted upon in 62% of these patients. The nursing documentation revealed that the delivery of oxygen was often insufficient to meet the patient's requirements and the medical staff were aware of less than half the patients with abnormal physiology. Discussion removed statement re pt survival: This research identified major deficiencies with recording patient vital signs. If these are not recorded regularly, patient deterioration will be missed and treatment cannot be initiated. Nurses need to respond to abnormal physiology beyond repeating vital signs and informing the medical staff. They are accountable for initiating interventions to prevent further deterioration. Conclusion: The early recognition of patient deterioration and treatment are essential to prevent cardiac arrest. Education strategies are required to improve compliance with recording patient vital signs, communication between nursing and medical staff and how to respond to patient deterioration. The barriers to these must be addressed and solutions sought if patient mortality is to be improved.