Quality Improvement Project: Vital Signs Documentation at Holmesglen

This project proposal, aimed at improving patient care, focuses on enhancing the accuracy and consistency of vital signs documentation in a healthcare setting. The project addresses the critical need for proper assessment, monitoring, and documentation of vital signs, recognizing their importance in formulating patient care plans and detecting potential health deteriorations. The proposal highlights the current issues with inadequate documentation practices, which lead to delayed or inappropriate treatments and adverse patient outcomes. It outlines the problem statement, national statistics, and the significance of the problem, emphasizing the impact of poor documentation on patient safety and quality of care. The project proposes a quality improvement initiative within the Holmesglen private hospital to standardize vital signs documentation. It details the current and ideal states, establishing measures to evaluate the project's effectiveness through surveys and data analysis. The project includes plans for staff education, protocol implementation, and continuous monitoring to ensure the project's success. The project aims to reduce patient health deterioration, decrease healthcare expenses, and improve overall patient outcomes by fostering a culture of accurate and timely documentation. This initiative aligns with the Institute of Medicine's dimensions of quality, aiming for safe, efficient, timely, effective, equitable, and patient-centered care.

Running Head: EVIDENCE BASED NURSING RESEARCH
EVIDENCE BASED NURSING RESEARCH
Name of the student:
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Reducing health deterioration of the patient by the appropriate documentation of Vital
Signs by Nurses
Vital signs are considered as the important part of the patient care. Vital signs are
assessed to gather the information that is required in formulating the care plan of the patient. The
proper assessment of the vital signs is extremely necessary, as the further treatment of the patient
is based on the vital signs of the patient (Osborne et al., 2015). The monitoring and
documentation of the vital signs is very essential for the enhanced care of the patient. According
to Wong et al., (2017), the proper documentation of the vital signs is one of the important part of
the patient care. The nurse and the healthcare staff should have the proper knowledge of
assessing, monitoring and documenting of the vital signs. According to a study conducted by the
Moreno et al., (2016), there are four main set of the vital signs which includes, pulse rate,
respiratory rate, blood rate and the body temperature. These parameters are considered to be one
of the most crucial in the proper assessment of the patient as it assists in providing precise patient
data that leads to improved patient care. Despite of its importance, very few researches has been
conducted on appropriate documenting of the vital signs assessment.
Problem statement:
This project is proposed to enhance the health outcome of the patient and to reduce the
patient health deterioration by the aid of proper documentation of the vital signs are conducted
by the healthcare staff. Proper documentation of the vital signs of the patient provides the precise
mirror image of the care of the patient. According to Després (2016), proper documentation of
the vital signs is not followed properly in several which hinders the quality of the patient care by
delayed and inappropriate treatment and leads to further deterioration of the patient’s wellbeing.

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According to IOM, to improve the patient care, the healthcare nurses should provide, safe,
efficient, timely, effective, and equitable and patient centered. If the vital signs are not measured
and documented, it hampers the aim of the IOM, which is safe and timely (Agency for
Healthcare Research & Quality, 2019).
National statistics:
According to the Safety and quality (2019), vital signs assessment and its proper
documentation is very important as it helps to reduce the patient health deterioration. It is
observed that one out of every 10 health care setting does not follow the proper assessment and
documentation of the vital signs, leads to negative impact on the patient’s health and delays the
recovery process. It is observed that due to the improper documentation patients have to stay
longer in the healthcare setting as compared to patient where proper documentation of the vital
signs are done.
Significance of the problem
Quality care in the healthcare setting is important to improve the patient health outcomes.
It is observed that there are several complications or error in the clinical area, which leads to
health deterioration. One of these is inappropriate or missing information in the documentation
of the vital signs is frequently observed in the healthcare setting which hampers the well-being of
the patient. The important parameters of the vital signs are often overlooked by the nurse, which
lead to inappropriate and delayed treatment of the patient (Kerr et al., 2016). Therefore, in order
to reduce the health deterioration of the patient, it is important to educate the nurse and the other
healthcare staff about the significance of the proper documentation in the patient care and its
consequences in the patient care quality.

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Background:
According to a study conducted by Stevenson et al. (2016), it can be stated that
documentation of the vital signs is one of the most crucial aspect of the patient care. It aids in
detecting the risk factors that are responsible for the patient health deterioration. For accurate
documentation of the vital signs, Electronic Health Records, but very few healthcare staffs are
aware about it. In the study, it is identified that appropriate documentation of the vital signs tends
to increase the health outcome of the patient, whereas delayed and the inappropriate
documentation lead to further deterioration of the patient’s well-being (Stevenson et al., 2016).
According to Cardona-Morrell et al. (2016), early assessment, monitoring and proper
documentation of the vital signs helps in the detection of the signs and symptoms responsible for
deterioration of the patient’s physical and mental wellbeing. It also helps the nurse and the
healthcare staff to formulate the care plan which aims to treat the signs and the symptoms which
eventually lead to reduced harm resulted from the serious adverse incidents. Accurate and timely
assessment and documentation of the vital signs ensures the safety of the patient (Cardona-
Morrell et al., 2016). Vital sign is monitored at regular interval and the change in the signs
should be documented properly. Proper documentation also helps the other nurse, healthcare
staff or the general practitioner in analyzing the current health condition of the patient. In case of
chronic illness, the vital signs fluctuate frequently (Cardona-Morrell et al., 2016). Hence, in such
case proper documentation of the each assessment helps to determine the health issue of the
patient and aids in clinical judgment. In the study conducted by the Stevenson et al. (2018), it is
identified that there are two primary reasons for the improper documentation among the nurses
and other health care staff in the healthcare setting. First is the lack of appropriate guidelines of
assessing and documenting the vital signs and symptoms of the patient, which leads to the

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inconsistencies in the recording of the vital signs and the second reason is the absence of
adequate facilities such as, electronic health records which might help the healthcare staff in the
proper documentation (Stevenson et al., 2018). Inappropriate documentation of the vital signs
misleads the general practitioner to provide appropriate treatment to the patient. In another study
conducted by Skyttberg et al. (2016), vital signs are necessary is considered as the important
aspect in the clinical decision making process, while taking care of a serious patient. The
documentation of the vital signs in the healthcare setting can be enhanced by educating or
advocating the nurse and the healthcare staff regarding the importance of the proper
documentation. In the study done by Skyttberg et al., (2016), different approach to improve the
quality of the documentation of the vital signs are mentioned which include, standardizing the
care process, improving the digital documentation, ensuring interoperability, providing the work
flow support and performing quality control. There are certain parameters of the vital signs that
need to be assessed, which include respiratory rate, pulse rate, oxygen saturation, heart rate,
blood pressure, body temperature and the conscious state (Jarvis et al., 2015). Monitoring of the
vital signs is an important part of the health care assessment and hence should be done in regular
interval. However according to Considine, Trotter and Currey (2016), nurse and the healthcare
staff tends to avoid proper monitoring and the proper documentation of the vital signs of the
patient. In the survey conducted by Considine, Trotter and Currey (2016), the respondents
answered that while assessing the vital signs of the patient, certain parameters are often
overlooked. From the result it can be concluded that body temperature and the conscious state
are rarely documented, which gives rise to an adverse event.
From the review, it is analyzed that the vital signs assessment is important in reducing the
health deterioration of the patient but is not properly done in the health care setting which lead to

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negative impact on the health of the patient. Hence, in order to enhance the health outcome, the
awareness regarding the significance of the proper documentation of the vital signs is created
among the nurses.
Project aim:
The aim of the project is to enhance proper and accurate documentation of the vital signs
which are responsible for the health deterioration of the patient. The aim of the project is to
improve the quality of the patient care by proper documentation of the vital signs in the
“Holmesglen private hospital'.
Current state:
By conducting a survey among the nurses and the healthcare staff of the Holmesglen
private hospital, it is deduced that the healthcare staff does not follow the proper protocol for the
appropriate documentation of the vital signs of the patient. Sometime the body temperature
which is one of the important of the parameters of the vital signs is avoided by the healthcare
staff which leads to reduced patient care quality. The nurses and the other healthcare staff who
works in the emergency department does not properly document the vital signs. In the current
state, due to inappropriate documentation, the patient health deterioration which leads to longer
stay at the hospital that increases the expense of the healthcare treatment increases. It poses an
additional burden in the patient and the family. According to Emanuel, Glickman & Johnson,
(2018), the patient suffering from chronic illness have to bear out of pocket expense in the
treatment of the patient. For the patient who does not have the medical coverage have to spend
around 10 times higher cost than that of the other individual, which is around $1000 per year.

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Ideal state:
The ideal state in this case is that the nurses and the other healthcare staff should
appropriate document the vital signs of the patient. All the important parameters of the vital
assessment which include respiratory rate, pulse rate, oxygen saturation, heart rate, blood
pressure, body temperature and the conscious state of the patient in the emergency department is
monitored regularly and properly documented. The health care expense decreases thereby,
reducing the financial burden of the treatment.
Establishing measures:
To evaluate the effectiveness of the project, survey among the healthcare staff and the
nurses should be conducted. The nurses are provided with the questionnaire which will assist to
evaluate the learning and knowledge of the nurses about the vital signs assessment and its
documentation. The result evaluated is compared with the previous survey’s result which has
been conducted at the beginning to gather the baseline information (Zhang et al., 2016). The
quality of the patient care is also determined after the project. It is expected that the patient care
quality has been improved. If the quality of the patient care is proved to be enhanced, the project
is said to be successful. The patients are also surveyed before and after the project, and the
results are then compared.
Project details:
Plan:
The plan of the project is to apply the code of Professional conduct by the nursing and
Midwifery council to improve the patient care quality. Authorization from the higher authority is

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taken to complete the project in the healthcare organization (Kerzner, 2017). Consent from the
patient and the healthcare staff is also taken into consideration. The budget of the project is
finalized. Before beginning the intervention, a pre-survey should be conducted among the
healthcare staff and the patient to evaluate the current state. For the project, each and every nurse
should be handed with a protocol which should contain the principle of the proper
documentation. After the completion of the project, the results are evaluated and the findings are
then shared among the healthcare organization. To educate the nurse about the importance,
different programs will be done which will require around $500-$800 (Emanuel, Glickman &
Johnson, 2018). The financial burden on the family and the patient will also decrease.
Do:
A meeting is conducted among the nurse and the healthcare staff of the emergency
department where they are handed with a protocol and principles of the proper documentation.
According to American Nursing Association, (2019), there are six main principles of the proper
documentation which are, knowledge regarding the documentation characteristics, education and
training, procedures and policies, protection systems, documentation entries and the standardized
terminologies. After documenting they should report to the supervisor to evaluate the
appropriateness of the documentation. The documentation includes all the important parameters
of the vital signs such as, respiratory rate, pulse rate, oxygen saturation, heart rate, blood
pressure, body temperature and the conscious state of the patient. the nurses are trained with the
strategies for proper documentation.

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Study:
Another survey is conducted after completing the project. Froe the result, it can be stated
that with the proper documentation of the vital signs in the Holmesglen private hospital, the
quality of the patient care have been improved. With proper documentation, the general
practitioners are also able to formulate accurate care plan. Though there are some barrier noticed
which include absence of nurse during the training.
Act:
From the study, it is observed that proper documentation improves the patient care
quality. Hence after some time again survey is conducted to evaluate whether the healthcare staff
of the Holmesglen private hospital are following the protocol or not. Strategies to avoid the
barrier are also implemented.
Dissemination:
Dissemination is demarcated as the planned process which includes the consideration of
the setting or the target audience where the evaluated research findings is to be send or received.
It involves communication or the interaction of the researcher with the wider audience that will
help to facilitate the research uptake in the decision making process (Hamann & Reitz, 2017).
The primary purpose of the dissemination is to influence the audience, in order to create
awareness regarding the change (Kleinpell et al., 2017). The findings of the project is evaluated
locally among the healthcare staff, nurses and the general practitioner, so that they will be able to
learn the benefit of the proper documentation and regular monitoring of vital signs assessment in
the emergency care department. Apart from these, the findings are also shared with the other
healthcare organization, so that the awareness will be created among the staff of the other

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organization also. In addition, the research should be available online so that every healthcare
organization can access the information.
Project summary:
In the healthcare setting, it is frequently observed that the assessment of the vital signs is
not done properly. Appropriate documentation is also not done by the nurse and the healthcare
staff on the regular basis. Appropriate assessment, monitoring and documentation are extremely
important in the case of patient suffering from the acute illness. In order to create awareness
regarding the vital sign documentation among the healthcare settings is initiated. The project
aims to improve the quality care of the patient by the help of the appropriate documentation of
the vital signs of the patient. The project is conducted at the emergency department of the
Holmesglen private hospital, and the respondents selected for the experiment are the patient
suffering from acute illness. The result of the project is expected to enhance the patient care
quality. The research findings obtained are disseminated among the local, national and the global
healthcare organization to increase awareness regarding the accurate documentation of the vital
signs.

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Reference:
Agency for Healthcare Research & Quality. (2019). Six Domains of Health Care Quality |
Agency for Healthcare Research & Quality. Retrieved 10 August 2019, from
https://www.ahrq.gov/talkingquality/measures/six-domains.html
American Nursing Association (2019). Retrieved 10 August 2019, from
http://www.nursingworld.org/~4af4f2/globalassets/docs/ana/ethics/principles-of-nursing-
documentation.pdf
Cardona-Morrell, M., Prgomet, M., Lake, R., Nicholson, M., Harrison, R., Long, J., ... &
Hillman, K. (2016). Vital signs monitoring and nurse–patient interaction: A qualitative
observational study of hospital practice. International journal of nursing studies, 56, 9-
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Considine, J., Trotter, C., & Currey, J. (2016). Nurses' documentation of physiological
observations in three acute care settings. Journal of clinical nursing, 25(1-2), 134-143.
Després, J. P. (2016). Physical activity, sedentary behaviours, and cardiovascular health: when
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Emanuel, E. J., Glickman, A., & Johnson, D. (2018). Measures of the Burden of Medical
Expenses—Reply. Jama, 319(15), 1621-1622.
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Science. In EGU General Assembly Conference Abstracts (Vol. 19, p. 14439).

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Jarvis, S., Kovacs, C., Briggs, J., Meredith, P., Schmidt, P. E., Featherstone, P. I., ... & Smith, G.
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