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Pulse oximetry and the enduring neglect of respiratory rate assessment: a commentary on patient surveillance

24 October 2019
Volume 28 · Issue 19


Clinical surveillance provides essential data on changes in a patient's condition. The common method for performing this surveillance is the assessment of vital signs. Despite the importance of these signs, research has found that vital signs are not rigorously assessed in clinical practice. Respiratory rate, arguably the most important vital sign, is the most neglected. Poor understanding might contribute to nurses incorrectly valuing oxygen saturation more than respiratory rate. Nurses need to understand the importance of respiratory rate assessment as a vital sign and the benefits and limitations of pulse oximetry as a clinical tool. By better understanding pulse oximetry and respiratory rate assessment, nurses might be more inclined to conduct rigorous vital signs' assessment. Research is needed to understand why many nurses do not appreciate the importance of vital signs' monitoring.

Nursing surveillance is essential for patient safety and outcomes (Kelly and Vincent, 2011). The common method for performing this surveillance is the rigorous assessment of vital signs. These signs provide critical data on the patient's response to treatment and feedback on changes in their condition. When vital signs are assessed accurately, clinical deterioration can be identified early and responded to expediently, providing the opportunity to reduce or avoid patient mortality (Bleyer et al, 2011; Flenady et al, 2017). This can only occur, however, if nurses understand the physiological basis and importance of vital signs and that these signs are assessed, communicated and acted upon (Armstrong et al, 2008).

Although vital signs' assessment provides important clinical data, research has consistently found the routine assessment, documentation and interpretation of these signs is frequently neglected (Hogan, 2006; Yeung et al, 2012). In an analysis of 79 patient assessments on two specialty wards in an Australian hospital, for example, a full set of vital signs (defined as temperature, pulse, blood pressure, respiratory rate and oxygen saturation) was measured only 21% of the time (Cardona-Morrell et al, 2016). It was speculated that numerous factors influence vital signs’ assessment such as nurses’ clinical judgement, time constraints and work distractions. Similar neglect of vital signs has been found in other research. In an audit of 241 adult cardiac arrests in a UK hospital, nurses failed to adhere to early warning score protocols in half of the cases; this protocol included interpreting and reporting vital signs (Odell, 2015).

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