What is the nursing time and workload involved in taking and recording patients’ vital signs? A systematic review

Abstract

Aims and objectives To synthesise evidence regarding the time nurses take to monitor and record vital signs observations and to calculate early warning scores. Background While the importance of vital signs’ monitoring is increasingly highlighted as a fundamental means of maintaining patient safety and avoiding patient deterioration, the time and associated workload involved in vital signs activities for nurses are currently unknown. Design Systematic review. Methods A literature search was performed up to 17 December 2019 in CINAHL, Medline, EMBASE and the Cochrane Library using the following terms: vital signs; monitoring; surveillance; observation; recording; early warning scores; workload; time; and nursing. We included studies performed in secondary or tertiary ward settings, where vital signs activities were performed by nurses, and we excluded qualitative studies and any research conducted exclusively in paediatric or maternity settings. The study methods were compliant with the PRISMA checklist. Results Of 1,277 articles, we included 16 papers. Studies described taking vital signs observations as the time to measure/collect vital signs and time to record/document vital signs. As well as mean times being variable between studies, there was considerable variation in the time taken within some studies as standard deviations were high. Documenting vital signs observations electronically at the bedside was faster than documenting vital signs away from the bed. Conclusions Variation in the method(s) of vital signs measurement, the timing of entry into the patient record, the method of recording and the calculation of early warning scores values across the literature make direct comparisons of their influence on total time taken difficult or impossible. Relevance to clinical practice There is a very limited body of research that might inform workload planning around vital signs observations. This uncertainty means the resource implications of any recommendation to change the frequency of observations associated with early warning scores are unknown.

Impact of the coronavirus pandemic on the patterns of vital signs recording and staff compliance with expected monitoring schedules on general wards

“…In addition, a recent systematic literature review has demonstrated insufficient robust evidence to quantify the nursing time and workload involved in measuring and documenting patients' vital signs. 16 Although work is currently underway to fill this knowledge gap, 17 it would be useful to study the time taken to complete these tasks with and without the use of PPE as this is relevant to determining practicable monitoring schedules. Moreover, there are significant barriers to efficient vital signs measurement and documentation, including when electronic systems are utilised.…”

How the Lagged and Accumulated Effects of Stress, Coping, and Tasks Affect Mood and Fatigue during Nurses’ Shifts

“…Nurses are exposed to significant stress at work, which can lead to burnout, provoking a deterioration in nurses’ health, a decrease in the quality of their care, and an increase in their intention to quit [ 1 , 2 , 3 , 4 , 5 ]. Two widely studied models of work stress have been tested in the context of nursing—Karasek’s Demand-Control model [ 6 ] and Siegrist’s Effort-Reward Imbalance (ERI) model [ 7 ].…”

How long do nursing staff take to measure and record patients’ vital signs observations in hospital? A time-and-motion study

“…Nurses often report missing essential patient surveillance due to high workload: one recent study found that around 35% of the vital sign observations scheduled according to an early warning score based protocol were delayed or missed (Redfern et al, 2019, Ball et al, 2014). However, the uncertainty around appropriate monitoring frequencies, and the impact these have on nursing workload, makes accurate workforce planning challenging (Smith et al, 2017, Dall’Ora et al, 2020a).…”

“…However, while these different approaches promise a more efficient use of nursing time with potential benefit to patients, there is currently little data to show how much time nurses spend on vital signs activities or to estimate potential savings (or costs) associated with change. A recent literature review found limited evidence with considerable variation between and within studies, 3 concluding that such uncertainty means that existing evidence cannot reliably inform workload planning for vital signs observations (Dall’Ora et al, 2020a). Limitations of existing research included lack of standardisation in measuring vital signs, and inadequate description of the observation methods used.…”