Is manual observation the answer?

Manual observation

In this day and age, everything is about technology, from using our phones to keep our lives in check, through to electronic healthcare records instead of our usual paper records, through to ehealth. But is all this technology really the answer for healthcare? Has technology in healthcare gone over the top and is manual observation really the answer?

Nurses across the UK are returning to manual observations, following evidence that reducing reliance on technology can dramatically improve care, Nursing Times has reported. It's reported that trusts are abandoning or planning to reduce their use of automated machines that take blood pressure readings, amid fears that they make it more difficult to monitor vital signs.

Installing an old-fashioned sphygmomanometer beside every hospital bed may seem at odds with 21st century quality healthcare. However, recalling this "key cornerstone in nursing provision from the past" has already contributed to a 30 percent reduction in unexpected cardiac arrest outside critical care that Salford Royal NHS Foundation Trust has achieved since signing up with Patient Safety First in 2008.

"At first the idea that taking blood pressure manually could be the more accurate option seemed crazy," recalls Peter Murphy, Assistant Director of Nursing for Quality Improvement. "In fact it makes good sense. When you take blood pressure manually, you also check the pulse and touch the patient's skin and look at their face, [which are] all very important clinical observations. Having a nurse on hand to explain what's happening, especially if there is a problem, is a better experience for the patient."

At Medway Foundation Trust, critical care consultant nurse Catherine Plowright is planning to replace automated machines in a surgical ward with traditional sphygmomanometers for a trial period this summer.

"Standing with the patient and talking to them may well be the thing that makes the difference in picking up vital signs," she said.

She said the move had attracted "mixed responses" from clinical staff, but monthly observation audits will reveal whether it has helped staff detect signs that patients' conditions are deteriorating at an earlier stage.

George Elliot Hospital Trust system

George Elliot Hospital Trust is introducing a system in the next three months where all blood pressure readings taken with automated machines will then be checked against manual readings.

Director of nursing, quality and workforce Dawn Wardell said: "We're using much more machinery now. There's a whole piece of work that needs to be done to show us whether we should keep [technology] across the board."

She hopes to gather evidence as to whether the two techniques produce different results.

A Nursing Times survey last year found 85 percent of respondents used automated technology to monitor vital signs. But 42 percent felt reliance on this equipment could make nurses less likely to identify, or act on, signs of patient deterioration.

Patient observation and the deteriorating patient is one of the central elements of a National Patient Safety Agency drive to increase engagement with nurses.

NPSA head of patient safety (deterioration) Kate Beaumont said there needed to be a debate as to whether there should be a wholesale return to manual observations, particularly for blood pressure readings.

She said: "It seems to be more accurate when someone has an abnormal blood pressure, particularly when it's low. But more importantly, it encourages and promotes an improved patient assessment by nurses because it encourages nurses to touch, feel and press."

Jodie Humphries

Jodie Humphries graduated from Bath Spa University with a BA Hons in Creative Writing in 2008. She has worked for GDS Publishing for the digital group since July 2009. She has previous experience with writing for the web, running her own website since April 2007.

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