G B Smith1, R Isaacs2, L Andrews3, M Y K Wee4, E van Teijlingen5, D E Bick6, V Hundley5. 1. Centre of Postgraduate Medical Research & Education (CoPMRE), Faculty of Health and Social Sciences, Bournemouth University, UK. Electronic address: gbsresearch@virginmedia.com. 2. Centre of Postgraduate Medical Research & Education (CoPMRE), Faculty of Health and Social Sciences, Bournemouth University, UK; Department of Anaesthesia, Southampton University Hospital NHS Foundation Trust, Southampton, UK. 3. Bournemouth University Clinical Research Unit (BUCRU), Faculty of Health and Social Sciences, Bournemouth, UK. 4. Centre of Postgraduate Medical Research & Education (CoPMRE), Faculty of Health and Social Sciences, Bournemouth University, UK; Department of Anaesthesia, Poole Hospital NHS Foundation Trust, Poole, UK. 5. Centre for Midwifery, Maternal & Perinatal Health, Faculty of Health and Social Sciences, Bournemouth University, UK. 6. Centre for Midwifery, Maternal & Perinatal Health, Faculty of Health and Social Sciences, Bournemouth University, UK; Florence Nightingale Faculty of Nursing and Midwifery/Division of Women's Health, King's College, London, UK.
Abstract
BACKGROUND: Obstetric early warning systems are recommended for monitoring hospitalised pregnant and postnatal women. We decided to compare: (i) vital sign values used to define physiological normality; (ii) symptoms and signs used to escalate care; (iii) type of chart used; and (iv) presence of explicit instructions for escalating care. METHODS: One-hundred-and-twenty obstetric early warning charts and escalation protocols were obtained from consultant-led maternity units in the UK and Channel Islands. These data were extracted: values used to determine normality for each maternal vital sign; chart colour-coding; instructions following early warning system triggering; other criteria used as triggers. RESULTS: There was considerable variation in the charts, warning systems and escalation protocols. Of 120 charts, 89.2% used colour; 69.2% used colour-coded escalation systems. Forty-one (34.2%) systems required the calculation of weighted scores. Seventy-five discrete combinations of 'normal' vital sign ranges were found, the most common being: heart rate=50-99beats/min; respiratory rate=11-20breaths/min; blood pressure, systolic=100-149mmHg, diastolic ≤89mmHg; SpO2=95-100%; temperature=36.0-37.9°C; and Alert-Voice-Pain-Unresponsive assessment=Alert. Most charts (90.8%) provided instructions about who to contact following triggering, but only 41.7% gave instructions about subsequent observation frequency. CONCLUSION: The wide range of 'normal' vital sign values in different systems suggests a lack of equity in the processes for detecting deterioration and escalating care in hospitalised pregnant and postnatal women. Agreement regarding 'normal' vital sign ranges is urgently required and would assist the development of a standardised obstetric early warning system and chart.
BACKGROUND: Obstetric early warning systems are recommended for monitoring hospitalised pregnant and postnatal women. We decided to compare: (i) vital sign values used to define physiological normality; (ii) symptoms and signs used to escalate care; (iii) type of chart used; and (iv) presence of explicit instructions for escalating care. METHODS: One-hundred-and-twenty obstetric early warning charts and escalation protocols were obtained from consultant-led maternity units in the UK and Channel Islands. These data were extracted: values used to determine normality for each maternal vital sign; chart colour-coding; instructions following early warning system triggering; other criteria used as triggers. RESULTS: There was considerable variation in the charts, warning systems and escalation protocols. Of 120 charts, 89.2% used colour; 69.2% used colour-coded escalation systems. Forty-one (34.2%) systems required the calculation of weighted scores. Seventy-five discrete combinations of 'normal' vital sign ranges were found, the most common being: heart rate=50-99beats/min; respiratory rate=11-20breaths/min; blood pressure, systolic=100-149mmHg, diastolic ≤89mmHg; SpO2=95-100%; temperature=36.0-37.9°C; and Alert-Voice-Pain-Unresponsive assessment=Alert. Most charts (90.8%) provided instructions about who to contact following triggering, but only 41.7% gave instructions about subsequent observation frequency. CONCLUSION: The wide range of 'normal' vital sign values in different systems suggests a lack of equity in the processes for detecting deterioration and escalating care in hospitalised pregnant and postnatal women. Agreement regarding 'normal' vital sign ranges is urgently required and would assist the development of a standardised obstetric early warning system and chart.
Authors: Lise Loerup; Rebecca M Pullon; Jacqueline Birks; Susannah Fleming; Lucy H Mackillop; Stephen Gerry; Peter J Watkinson Journal: BMC Med Date: 2019-09-11 Impact factor: 8.775
Authors: James Cheshire; David Lissauer; Will Parry-Smith; Aurelio Tobias; Gary B Smith; Richard Isaacs; Vanora Hundley Journal: Resusc Plus Date: 2020-12-30