Nursing Failure to Note Abnormal Vital Signs
Vital signs are objective measurements of the patient’s most basic body function. A change in vital signs can be a strong indicator of a decline in the patient’s health status. Normal readings are widely agreed to be within a specific range. In a medical setting, vital signs are often documented on the patient’s graphic page or flowchart to facilitate trending of the data. What is “normal” for the patient is established upon admission to a facility and monitored throughout the stay. Therefore, a change is the patient’s norm is the most important reading to note.
Abnormal readings should be pointed out to the physician during morning rounds or reported by telephone to the physician. The frequency of vital sign measurements is ordered by the treating physician or according to a set protocol of the unit. This frequency is a minimum of how often vital signs should be measured. Taking them more frequently is up to the discretion of the nurse and is based on the nursing plan of care.
The cases I have reviewed involving failure to note abnormal vital signs have two patterns I have seen repeated many times. The first is that the person taking the vital signs is a non-licensed person or LVN who is not noting a change or abnormality in the readings. Often, this is a situation where frequent vital signs are ordered for a post operative patient. They are moving in and out of the patient’s room without doing much more than this task alone because the patient may not have any demands or complaints due to being sleepy from recent anesthesia. A non-licensed person should report any abnormal vital sign readings immediately to their supervising RN.
The second pattern I have seen, besides failing to note and report abnormal vital signs, is when the licensed nurse is not observing other changes or taking the next step in nursing care of assessing the patient more thoroughly. As stated before, the frequency of vital sign readings can be done more frequently in an unstable patient. Abnormal findings should trigger further investigation of the cause. Unfortunately, I have seen many situations where the RN allows a nurses aide to continue taking abnormal vital signs as ordered even when the patient needs to be observed more closely. The RN may be coming into the patient room and noting some obvious changes or complaints without recognizing the significance or reporting this to the physician. I have seen this kind of deterioration documented in the medical record where the RN finally acts when the patient loses consciousness, loses their heart rate or blood pressure completely.
While there would be little debate that not reporting abnormal vital signs is below the nursing standard of care one has to ask if this omission impacted the patient’s condition to the point of proximately causing significant damages. In many states, physicians cannot provide expert opinions about nursing care and nurses cannot opine on causation issues since the scope of nursing practice does not encompass diagnostics. Determining which expert to review the records first depends on the many complexities of the case. Often, a step-wise approach is best.
Wyeth Effexor Suit
Aaron v. Wyeth, No.
2:07cv927 involves a patient on Effexor who eventually committed
suicide. Instead of suing the doctors, the estate representative sued
Wyeth, the maker of Effexor.
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