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  • 1.  Vital Signs

    Posted 19 days ago

    Hi, I work in a University Medical Center with primary care and specialty clinics.  The specialty clinics occasionally ask if vital signs are required at every visit.  I am wondering if anyone has policy or guidelines for required vital signs in different clinics or visit types?

     

    Thank you,

     

    Amy Wasilewski MS, RN, AGCNS-BC, NPD-BC                             

    Assistant Director of Ambulatory Nursing Safety and Quality

    University of Rochester Medical Center

    135 Corporate Woods, Suite 130

    Box 680

    Rochester, NY 14623

     

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  • 2.  RE: Vital Signs

    Posted 10 days ago

    Hi Amy, 

    I think it depends on the facility and the specialty.

    At my previous job, at an ambulatory center affiliated with a county hospital, I also worked in both primary and speciality care clinics. To my knowledge, we did not have any specific policy or guideline stating we had to complete vital signs for each speciality clinic. Whether we took vitals or not depended on the specialty itself/what the speciality providers wanted. For example, we were told to complete routine vital signs in our pediatric psychiatry, adult neurology, adult rheumatology, and adult nephrology clinics (to name a few clinics). On the other hand, we we told we didn't need to complete vitals in our ENT, polio, or anticoagulation clinics; we would take vital signs PRN depending on the patient's condition. 

    Also, before I was a RN, I worked in the optometry department (considered a specialty clinic) for Kaiser Permanente and we were required to check vital signs if the patient's chart flagged that they were due for a BP check.




  • 3.  RE: Vital Signs

    Posted 6 days ago

    Hello,

    My organization developed an Ambulatory Rooming policy which outlines that departments may determine what parts of the rooming navigator to complete, for example vital signs, review of allergies, medications and tobacco use. This means that different ambulatory departments may identify which (if any) vital signs will be obtained, for example family medicine obtains components of vital signs pertinent to the visit (respiratory rate and oxygen sat in patients with a respiratory concern, full set including height and weight for physicals) and psychiatry only obtains vital signs specific to medication monitoring. 

    Thanks,

    Dedria



    ------------------------------
    Dedria Sowder, MSN-Ed, RN, AMB-BC, NPD-BC, CPN
    Leadership SIG Past Chair
    Ambulatory Clinical Practice and Regulatory
    Carilion Clinic, Roanoke Virginia
    drtuck@carilionclinic.org
    540-314-3028
    ------------------------------

    Original Message


  • 4.  RE: Vital Signs

    Posted 3 hours ago

    Good evening Amy, 

    Good question I have not seen a universal guideline mandating a full set of vital signs at every ambulatory visit. In my virtual setting national clinic vital signs are not collected, we aim to perform some form of teaching and screening as patients won't always have access to vital sign equipment. I think that the organization should have clear policies based on patient condition, reason for visit, specialty, medications and planned procedures. CMS guidance emphasizes the documentation of vital signs and other information needed to monitor the patient's condition, rather than requiring the same measurements at every type of encounter.
     
    For example, blood pressure is important for hypertensive patients or when medication may affect blood pressure, whereas oxygen saturation may be more relevant in pulmonary clinics or patients with respiratory symptoms. Weight may be particularly important in heart failure, nephrology, nutrition and oncology clinics. Some measurements that are required for a routine postoperative wound check or short follow-up may be required for a new-patient evaluation.
     
    It may be useful to develop a standardised matrix which identifies the minimum vital signs required by specialty and visit type, and criteria for requiring a complete set. The policy should also allow the nurse to obtain additional vital signs as symptoms, clinical judgment or change in condition dictates. This can reduce unnecessary work, whilst ensuring patient safety and consistency across clinics.



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