‘It’s not difficult, takes about five minutes … when do they decide vital signs are not important?’

The vital signs of 58 patients across the country – including tiny babies – were not properly checked or responded to by nurses before their deaths, with an expert now questioning why.

A combination of individual and institutional failings may be to blame for breathing rate, pulse, blood pressure and temperature checks not being prioritised.

More than 50 babies and adults were denied basic, essential medical care before their deaths in public and private hospitals across Australia, an audit by Victorian researchers has found.

Coronial records show the vital signs of 58 patients – aged seven days to 93 years – were not properly checked or responded to by nurses before their deaths.

While checking their vital signs would not have saved their lives, the researchers said it could have delayed their deaths.

Led by Monash University’s Department of Nursing and Midwifery, the research team said checking vital signs was a critical task performed by nurses as abnormal vital signs were strongly associated with adverse outcomes.

Vital signs assessments are not always being performed as they should be. Picture: Getty

The findings reflected, they said, a combination of individual and institutional failings and suggested these assessments — such as breathing rate, pulse, blood pressure, temperature and level of consciousness — were not considered a priority.

“What’s most significant here is that it is a fundamental, basic nursing task. It is not difficult and takes about five minutes and you have equipment to help you do it,” lead author and Monash University nursing lecturer Dr Malcolm Elliott said.

Examples in the audit included a patient who was haemorrhaging on the operating table, but staff tolerated an extremely low blood pressure because they were waiting for blood to arrive from the blood bank. In another, there were no observations carried out on a patient for almost 12 hours.

“My question moving forward is why is this happening?” Dr Elliott said.

“I think it comes down to lack of understanding, but as a nurse academic I know we teach students the importance of vital signs so I want to know when do they decide that vital signs are not important?”

Researchers say the assessments are a fundamental, basic nursing task.

The team, that also included Monash’s Roz Williamson and Dr Ruth Endacott from the National Institute for Health and Care Research in London, used Australian coronial data to retrospectively explore the link between failure to assess a patient’s vital signs and their death.

“Unfortunately some nurses don’t seem to appreciate the vitalness of vital signs,” Dr Elliott said.

“(But) poor monitoring is not always the ward nurses’ fault. Sometimes it is workload, and sometimes the patient has been sent from intensive care and is too sick to be on a ward.

“It needs to be seen by senior nurses as a priority.”

The study, published in the journal Nursing in Critical Care, reviewed 1287 deaths between 1 January 2015 and January 2020.

They said key themes in their audit related to the absence of reassessment, inappropriate delegation, passing responsibility to another staff member and not following policy.

The researchers said the findings suggested that despite nurses being aware of the correct process or policy regarding vital signs’ assessment, many were choosing not to do it rigorously.

Dr Elliott next wants to do a national audit to understand how to determine if a nursing student is competent at checking vital signs.