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Research project: Study of the knowledge, beliefs and behaviours of hospital staff involved in patient monitoring to identify factors affecting performance of scheduled night time observations

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Following on work undertaken at Portsmouth Hospital NHS Trust, which identified lower compliance levels of scheduled vital signs observations by nursing staff at night, the aim of this project is to determine the factors that influence vital signs observation during night shifts on general medical and surgical wards.

Project Overview

This project is a two-stage exploratory observational mixed methods study consisting of a quantitative survey and in-depth semi-structured qualitative interviews. This project is a two-stage exploratory observational mixed methods study consisting of a quantitative survey and in-depth semi-structured qualitative interviews.

Portsmouth Hospitals NHS Trusts (PHT) developed VitalPACTM, an electronic patient surveillance system where the frequency of vital signs observations is calculated by an Early Warning Score (EWS) protocol. The system assures that patients be observed more frequently, allowing for the identification of early physiological changes that indicate deterioration. Since implementation, regular audits have consistently shown significant differences in adherence to the observation protocol during the night shift, between wards within the same clinical directorate and between medical and surgical specialties.

Based on the hypotheses that compliance of observations would be influenced by:

  • Nurse’s experience
  • Knowledge of the EWS protocol
  • Beliefs regarding the importance of sleep and the predictability of deterioration
  • Attitudes regarding the importance of prioritising and completing vital signs observations in relation to all the other nursing tasks that need to be done

Our study aimed to:

  1. Ascertain the knowledge, beliefs, choices and practices of healthcare staff concerning performing vital signs observations at night on general medical and surgical wards
  2. Ascertain factors associated with ward level observation compliance and individual self-reported compliance

Results of the study will inform a review of the hospital guidelines regarding night time observations in order to:

  • Identify improvement areas and
  • Deliver a short training workshop to nurses and staff to increase adherence of night time observations according to established policies

A second study should follow to determine the impact of missed night observations on selected patient outcomes

Project Team

Dr Paul Schmidt (Portsmouth Hospitals NHS Trust)

Dr Alejandra Recio-Saucedo

Dr Antonello Maruotti

Dr Greta Westwood

Dr Meredith Paul (Portsmouth Hospitals NHS Trust)

Carole Fogg

Jo Hope

Professor Peter Griffiths

& members of the Deteriorating patient group at Portsmouth Hospital NHS Trust

Project Funder

CLAHRC Wessex

Conferences and events

Portsmouth Research & Innovation Conference, Portsmouth, UK, 15 June 2016

Seminar presentation organized by CLAHRC Wessex Fundamental care theme, University of Southampton, Faculty of Health Sciences, January 2016

Associated research themes

Early identification of physiological deterioration

Early Warning Scores

Electronic patient surveillance systems

Related research groups

Health Work and Systems

Staff

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