Ms Sandy Rolfe (Respiratory Nurse Specialist, NHS Tayside) recently wrote for the British Journal of Nursing about ‘The importance of respiratory rate monitoring.’ This is the process undertaken by clinical staff of manually counting a patients’ breaths for one minute and recording that figure in the patients’ notes, along with their other vital signs. Rolfe highlights the reasons why respiratory monitoring is so important, how it can sometimes fall foul of inaccuracy and how it could be improved. Her key findings are summarised here.
Why is accurately measuring respiratory rate so important?
Respiratory rate is one of the four main vital signs that nurses are relied upon to accurately monitor to detect possible patient deterioration. Changes in respiratory rate can indicate early onset of serious conditions such as pneumonia, sepsis, post-operative respiratory failure and now also COVID-19.
“Respiratory rate is an early, extremely good indicator of physiological conditions such as hypoxia (low levels of oxygen in the cells), hypercapnia (high levels of carbon dioxide in the bloodstream), metabolic and respiratory acidosis.”
Healthcare settings in the UK use Early Warning Scores (EWS), specifically NEWS2 to determine the condition of a patient based on all their vital signs. Recent evidence suggests that an adult with a respiratory rate of 20 breaths per minute is probably unwell and an adult with a respiratory rate of over 24 breaths per minute is likely to be critically ill.
“Recognising trends using NEWS2 should help reduce significant deterioration of patients if acted upon judiciously.”
The below example demonstrates how increased respiratory rate can indicate patient deterioration before oxygen saturation (sao2) levels. Even as breaths reach 23 per minute, oxygen saturation is still at 97%. This is because the body is compensating for lack of oxygen by taking more breaths. Here the EWS is being driven up by the increasing respiratory rate.
“Health professionals need to recognise the significance of accurate vital sign monitoring especially in terms of the respiratory rate.”
Why is accurately measuring respiratory rate so difficult?
Healthcare professionals are often time poor, with increased pressure to effectively care for multiple patients whilst also improving outcomes.
Manually recording an accurate respiratory rate is difficult and time consuming. Healthcare professionals are required to stand with the patient with their hand on their chest, watching the chest wall rise and fall with each breath, whilst also timing themselves for 1 minute with a watch. At the end of that time they are required to record an accurate respiratory rate as one of that patient’s vital signs, which then may not be measured again for several hours.
“Evidence suggests that health professionals do not prioritise the measurement of respiratory rate; this is observed as being down to poor knowledge, lack of time or lack of prioritisation.”
How can accurately measuring respiratory rate be improved?
Healthcare professionals need to be more proactive and efficient in the measurement and recording of respiratory rate to improve detection of patient deterioration. The following changes could all have an impact:
- Improved training in the importance of accurately measuring respiratory rate in line with NEWS2 guidelines
- Changes in healthcare policy to further prioritise respiratory rate monitoring
- Introduction of respiratory rate monitoring technology such as RespiraSense.
“The lack of reliable equipment to measure respiratory rate has been cited as a possible reason for poor monitoring.”
RespiraSense allows healthcare professionals to become more efficient, proactive and responsive through the availability of accurate, real time, critical respiratory rate data. Contact us for more information.