Standards for frequency of measurement and documentation of vital signs and physical assessments.

LuAnn Staul is a critical care clinical nurse specialist for Legacy Health System in Portland, Oregon. vital signs a minimum of every 2 hours. Frequently, however, vital signs are noted every 1 hour, and sometimes as often as every 5 to 15 minutes, depending on the patient’s condition. The individual characteristics of the patient as articulated in the American Association of CriticalCare Nurses Synergy Model— stability, complexity, predictability, vulnerability, and resiliency (see Table)—should serve as the framework for determining the frequency of assessment. Using this framework, patients who are at greatest risk for an adverse outcome (eg, patients with frequently changing physiological status, whose response to specific therapy requires close monitoring) should receive more frequent assessments. In addition, the policy should also allow the nurse to individualize frequency of assessment on the basis of the patient’s medical diagnosis, comorbid conditions, types of treatments, and where the patient is in his or her hospital course. For example, a trauma patient newly admitted to the critical care unit requires more frequent assessment than does a patient who is ready to be discharged to the acute care area. As the patient’s condition improves, AChristine S. Schulman, RN, MS, CNS, CCRN, and LuAnn Staul, RN, MN, CNS, CCRN, reply: