12.03.2021

Vital Signs – Now and Then

by Cindy Fronning, RN, GERO-BC, IP-BC, AS-BC, RAC-CT, CDONA, FACDONA, Master Trainer, Director of Education NADONA

The definition of vital signs by encyclopedia.com states “(vital signs that) can also be called simply vitals, are four measurements taken to determine whether a person is alive. The English word vital comes from the Latin vitalis, which means “pertaining to life” or “alive.”¹ Knowing what each vital sign is measuring is extremely important but knowing how to interpret the vital signs in an aging population is as important.

The monitoring of vital signs began as early as 1625 when Santorio of Venice and Galileo published how to measure body temperature using a spirit thermometer. A spirit thermometer uses ethanol alcohol vs a later dated mercury thermometer. Sir John Floyer published the first scientific report in 1707 on timing a pulse using a pendulum. In 1852 Ludwig Taube published a report on a plotted course of a fever and added the respiratory rate to the vital signs then being tracked. With the improvements in the thermometer and clock, temperature, pulse, and respiratory rates became standard measurements by the medical professionals during this period of time.

The first blood pressure cuff (sphygmomanometer) measuring arterial blood pressure, was introduced in 1896. This became the 4^th vital sign. Willem Einthoven is credited with the invention of the string galvanometer which measured the ECG and was the forerunner of the EKG machine in 1903.

Today there is much discussion of what are considered vital signs and what are the most important vital signs to track. Is it TPR (temperature-pulse-respirations) and B/P (blood pressure) plus SpO₂ (oxygen saturation) or pain or activity or height & weight?

Regardless of which additional signs are added the core 4 remain unchanged. I found this quote in an article about vital signs “The reason why vital signs are so vital is because they are not subjective. Your heart rate is your heart rate.”²

Vital signs reveal how the body is functioning. They include:

Blood pressure measures the force of your blood pushing against the walls of your arteries. A normal blood pressure reading for adults ranges between 90/60 mm Hg to 120/80 mm Hg
Heart rate (pulse) measures how fast your heart is beating. An adult will experience a pulse between 60 to 100 beats per minute.
Respiratory rate measures your breathing. A healthy adult will exhibit 12 to 18 breaths per minute.
Temperature measures how warm your body is. 97.8°F to 99.1°F (36.5°C to 37.3°C) with an average of 98.6°F (37°C).

The additional vital sign of Oxygen saturation (SpO₂) is being used more and more. SpO₂ measures the percentage of oxygen-carrying hemoglobin in the blood. Normal levels range from 95% to 100%.

Vital signs are used in the doctor’s office as a baseline and to know when the patient might be trending towards or having an acute illness. In the ER VS are used to look for extremes to help diagnose what might be going on with the patient.

This leads us to discuss accuracy. Thorough and accurate vital signs are crucial to ensure that a physician is able to ask the appropriate questions pertinent to the resident’s history, current illness and allows the physician to do an effective physical exam, and provides information to make an accurate diagnosis and effective treatment plan.

As medical professionals, it is our obligation and responsibility to obtain accurate vital signs. Proper technique is necessary to obtain accurate vital signs. This is accomplished by performing the procedure repetitively. As a leader in the medical field (Hospital, Nursing home, clinic, etc.), it is also our responsibility to ensure the competence of our staff when it comes to taking vital signs and the accurate recording of them. If vital signs are obtained that have an extreme or unexpected change, a recheck of them should occur by a supervisor. Education and competency checks are a continuous process to safeguard our resident’s health and appropriate quality healthcare.

It would appear that the more frequent vital signs are taken, it is more likely we would discover declines in health on an earlier basis. This leads to better quality care. Although this would seem to be prudent, we have to balance that with the time it takes to do vital signs and the number of staff required to facilitate the frequent VS (vital signs) process. A study done in England reported in the International Journal of Nursing Studies that it takes between 5 minutes and 1 second without interruptions and 6 minutes 26 seconds with interruptions. All interruptions noted were not VS-related. Documentation also takes time. Depending on how the data is documented such as on paper and then transcribed or electronically at the bedside which then transmits the VS data to the Electronic Health Record (EHR). Thinking about the number of residents that need vital signs taken and then the more than once frequency certainly eats up the staff member’s time.

This is time-consuming and begs the question of how can we direct more of the staff time to the bedside, caring for the resident?

Modern technologies are being designed each year. They have evolved from the early years to electronic thermometers, skin thermometers to devices that travel on wheels and contain all the equipment to more portable devices. These devices utilize digital signal processing, and new sensors that more accurately read the measurements, blood pressure, electric heart signals, blood oxygen, and temperature.

These vital sign monitors allow healthcare staff to be more efficient, more accurate and have the ability to evaluate the patient/resident quicker. Thus, providing the information needed to assess their overall condition. These diagnostic tools (monitors) are compact and very accurate. “Typically, vital signs monitors measure a patient’s main bodily functions including temperature, pulse rate, respiration rate, blood pressure and lastly, blood oxygen levels.”³

These modern devices are much faster, are primarily digital, non-invasive, and often combine several analytic features into a single small device. There are several different devices on the market today.

It makes sense then to look to technology to assist with the time and accuracy concerns instead of trying to find, hire and train more staff and keep having the same outcomes we have had in the past such as inaccurate VS, less than adequate frequency of VS that are needed and missing declines thus providing poorer quality of care. We have come a long way since the spirit thermometer!

There is a system currently available that does this and more. It is called the VIOS Monitoring system. It monitors vital signs, whether the patient/resident is in bed or up and about. It is wireless and uses Bluetooth technology. It is monitored off-site by trained individuals and they communicate with the nursing staff if irregularities are noted. It works on a 24/7 basis and can assist the nurse in having more time to actually care for the resident instead of taking vital signs. This system tracks with a 7 lead ECG, heart rate, respiratory rate, non-invasive blood pressure, pulse rate, SpO₂, posture, and body temperature. There are several other monitoring systems but this is the only one where someone other than the facility staff is monitoring the data on a real-time basis.

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Vital Signs – Now and Then

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