RESEARCH PAPER

A COMPARISON OF AN EVIDENCE BASED REGIME WITH THE STANDARD

PROTOCOL FOR MONITORING POSTOPERATIVE OBSERVATION:
A RANDOMISED CONTROLLED TRIAL
Ritin Fernandez, RN, MN (CritCare), Deputy Director, South ACKNOWLEDGEMENTS
Western Sydney Centre for Applied Nursing Research, Adjunct We thank all the patients who participated in this trial, and the nursing and
Research Fellow, School of Nursing, Family and Community medical staff at the participating hospital for their support of the project. Thanks
Health University of Western Sydney, New South Wales, Australia. also to Megan Stephens for assistance with data collection, Margaret Piper and
Penny Murie for assistance with recruitment and Rachel Langdon for statistical
[email protected]
advice and assistance.
Rhonda Griffiths, MSc (Hons), DrPH, Research Professor,
School of Nursing, Family and Community Health, University of
Western Sydney, Director, South Western Sydney Centre for
Applied Nursing Research, Director, New South Wales Centre
for Evidence Based Health Care, New South Wales, Australia
Accepted for publication November 2004

Key words: postoperative, post surgery, monitoring, vital signs, observations

ABSTRACT Conclusion
This study provides evidence to inform clinicians of
Background a safe and cost effective regime in the management of
Monitoring patients vital signs is an important the patient in the postoperative period following
component of postoperative observations. discharge from the recovery to the ward. Clinicians,
however, must utilise clinical judgement to determine
Objective which patients require close monitoring during the
To compare the safety and efficacy of the current postoperative period.
standard practice for monitoring postoperative
observations in one hospital with an experimental
protocol. INTRODUCTION
Method

M
onitoring of patients vital signs is an important
Patients who were classified as American Society of component of postoperative observations,
Anaesthesiologists (ASA) Class 1 or 2 and who met the undertaken for the early detection of
inclusion criteria were randomised to one of two complications that may require an intervention, thus
groups. Following their return to the ward from the preventing further clinical deterioration (Botti and Hunt
1994). Research has demonstrated that 5% of patients
recovery unit, these patients were monitored according
develop postoperative complications (Gamil and Fanning
to either the standard practice (n=96) or the
1991), 0.21% of patients developed an early postoperative
experimental protocol (n=93). Data collected included
emergency within 48 hours after surgery (Lee et al 1998),
patient demographics, medical and surgical history,
and the incidence of mortality is 0.24% in the first 24
the postoperative observations and the number and
hours following surgery (Gamil and Fanning 1991).
type of untoward events.
A large number of studies have been published which
Results provide recommendations specifically for monitoring
The findings indicated that there was no patients in the recovery room, however there has been
statistically significant difference in the incidence of limited research relating to management of patients
abnormal vital signs between the groups in the first following their transfer to the ward.
four hours as well as within the 24 hours following The commonly monitored vital signs include
return to the ward from the recovery unit. temperature, pulse, respiration and blood pressure (Evans
Additionally, none of the patients required either et al 1999). Nurses usually assess these vital signs in
transfer to the intensive care unit /high dependency accordance with the individual hospital protocols
unit or management by the intensive care team. (Botti and Hunt 1994), although the rationale for these
Patients in both groups were successfully discharged protocols are rarely based on scientific evidence
within 24 hours following surgery. (Arsenault 1998; Burroughs and Hoffbrand 1990).

Australian Journal of Advanced Nursing 15 2005 Volume 23 Number 1

 RESEARCH PAPER

Policies and protocols for monitoring patients RESEARCH QUESTION

following return to the ward varies between facilities as
well as between wards within each facility. For example What is the effect of a modified regime compared to
half hourly monitoring for two hours, hourly monitoring existing practices for monitoring vital signs in
for four hours and hourly monitoring for six hours have postoperative patients on their return to the ward from the
been reported (Zeitz and McCutcheon 2002). recovery unit?

Findings from a systematic review of the literature

(Centre for Applied Nursing Research 1998) investigating MATERIALS AND METHODS
the optimal frequency for monitoring patients on return to A randomised controlled trial was undertaken
the ward, recommended that vital signs should be comparing the incidence and nature of untoward events
monitored half hourly for two hours followed by fourth that occurred in the first 24 hours following return to the
hourly for 24 hours if the patients were stable. However, ward after surgery in patients monitored according to the
the systematic review did not include recommendations study protocol and those monitored according to the
for the type of observations, therefore a further review of standard hospital protocol. This study design was chosen
the literature was undertaken to identify the common due to the ability of randomised controlled trials to
complications occurring in the first three postoperative eliminate selection bias thus making them the best
days and the associated vital signs to be monitored. method to obtain evidence on the effects of health care
The findings from this literature review identified interventions.
hypotension as a common complication occurring within The study was conducted in a metropolitan health
the first three hours after surgery (Gamil and Fanning service in New South Wales, Australia, over six
1991) therefore the value of blood pressure monitoring consecutive months. As such a study had not been
was confirmed. Likewise, the recording of pulse rate was previously undertaken it was determined that only
justified because bradycardia has been reported as the patients classified by the American Society of
second most common complication occurring within Anaesthesiologists (ASA) as Class 1 or 2 would be
the first two hours after surgery (Field 1998). The included. The ASA Classification status (table 1) was
literature also indicated that monitoring the temperature used as an estimate of operative risk (Wolters et al 1996).
in the first four hours has been frequently recorded to
detect hyperthermia, which is primarily an indicator of Table 1: ASA Classification
infection (Litwack 1997; Wipke-Tevis 1999), DVT, ASA I The patient has no organic, physiological, biochemical,
pulmonary emboli, atelectasis (Pett and Wernly 1988) or psychiatric disturbance. The pathological process for
which the operation is to be performed is localised and
and anastomotic breakdown. Researchers have also is not a systemic disturbance.
demonstrated that these complications are uncommon in
the first few hours following surgery and are more likely ASA II Mild to moderate systemic disturbance caused either by
to occur from the second postoperative day (Heidenreich the condition to be treated or by other pathophysiologic
processes.
and Giuffre 1990).
The importance of monitoring the respiratory rate ASA.III Severe systemic disturbance or disease from whatever
cause, even though it may not be possible to define the
was debatable, as adequate breathing did not necessarily degree of disability.
indicate optimal ventilation (Thompson 1983). Rather,
monitoring oxygen saturation levels has been ASA IV Indicative of the patient with severe systemic disorder
demonstrated to be an important predictor of the patients already life-threatening, not always correctable by the
operative procedure.
respiratory status (Moller et al 1992; Moller et al 1993;
Rosenberg et al 1989). With the availability of bedside ASA V The moribund patient who has little chance of survival
technology (pulse oximetry) to record the patients but is submitted to operation in desperation.
oxygen saturation, monitoring the physiological results
of respiration rather the respiratory rate is a much Patients having surgery under general anaesthesia were
more appropriate indicator of respiratory status (Bayne identified on admission to the peri-operative unit and
1997). assessed by the departmental staff to determine their
Based on the findings of the systematic review and a eligibility for entry into the study. Patients were eligible
comprehensive literature review of the commonly for the study if they were scheduled for surgery under
general anaesthesia, between the ages of 18-80 years,
occurring complications in the early postoperative
transferred to the ward from recovery, and had a
period and in consultation with expert clinicians an
minimum length of stay of six hours following surgery.
evidence based postoperative monitoring regime was
developed. The objective of this study was to investigate Patients who failed to give consent, had surgery under
the safety and efficacy of the evidence based regime spinal or local anaesthesia, patient controlled anaesthesia
for monitoring postoperative observations with the following surgery, neurosurgery, vascular surgery or were
existing standard practice. transferred to the intensive care (ICU) or high

Australian Journal of Advanced Nursing 16 2005 Volume 23 Number 1

 RESEARCH PAPER

dependency units (HDU) from the recovery unit were ward then one hourly for two hours followed by four
excluded from the study. The surgeons and anaesthetists hourly for 24 hours.
reviewed the experimental protocol and consented to have
Data collection was undertaken by an independent staff
their patients participate in the study. The study was
member not associated with the research project.
approved by the South Western Sydney Area Health
Standardised data collection was undertaken using a tool
Service Research Ethics Committee and the University of
developed by the researchers. The data collector was
Western Sydney Ethics Review Committee (Human
provided with extensive education regarding transcription
Subjects).
of the data and the data collection method. Data collected
An intensive education program for staff in the included the patients age, gender, date of admission,
surgical wards was undertaken to provide details of the surgery and discharge, name of the surgical procedure,
study, procedures to be followed, and the documentation medical history, ASA class, duration of anaesthesia,
to be completed for each client enrolled in the study. duration of the procedure, length of time in recovery, the
At the time of admission to the peri-operative unit, observations recorded, and any variations in the condition
patients who met the inclusion criteria were informed of of the patient during the first 24 hours following surgery.
the study and written consent was obtained prior to Random audits by the researchers were conducted to
allocation to a study group. The randomisation sequence ensure accuracy of the data collected.
was generated from a statistical table of random numbers Adverse outcomes of interest included the number of
and concealed in sequentially numbered, opaque, sealed patients who developed any untoward events such as chest
envelopes. Following their return to the recovery unit after pain, required management by an intensive care team,
surgery, envelopes containing the monitoring regime were were transferred to the ICU/HDU for intense monitoring
placed by the nurse in charge, in front of the patients or had an abnormal vital sign. An abnormal vital sign was
medical notes. On transfer to the ward, the envelope defined as a value outside the predetermined parameters
containing the protocol was located; the random number (Davis and Nomura 1990) (table 4).
recorded on the data sheet, and the patient was monitored
according to the assigned protocol. Nurses were Table 4: Definitions and parameters of abnormal vital signs
instructed that in the event that a patient became unwell for the purpose of this study
and required further monitoring, the patient was to be Fever Temperature of 38.3 or higher
discontinued from the study and treatment commenced
according to medical/nursing advice. Hypoventilation Respiratory rate of 10/min or less

Patients in the control group had their observations Hyperventilation Respiratory rate of 30 or more
monitored according to the standard hospital protocol
(table 2) while those in the experimental group had their Hypotension Fall in blood pressure (BP) >20mm
observations monitored according the study protocol of Hg from baseline BP or systolic BP
<80mm of Hg
(table 3). Owing to the nature of the intervention, it was
not possible to blind the participants, nurses or the data Hypertension Systolic BP >180mm Hg and diastolic
collectors to the treatment allocation. However, in order to BP > 120mm of Hg; a rise in BP of 20%
maintain the rigour of the study and to avoid bias during or more than the highest preoperative BP
documentation, the nurses and the data collectors were
not informed of the criteria used to describe abnormal Bradycardia Pulse <60/min
Severity classified B1 50 60/min
vital signs. B2 <50/min
Table 2: Standard protocol (control)
Tachycardia Pulse >100/min
Temperature to be recorded on return to the ward then Severity classified T1 100 120/min
at the end of four hours followed by daily until discharge T2 >120/min
if the patient is stable. Respiratory rate, pulse rate, blood
Hypoxia 02 saturation 90% or less
pressure, oxygen saturation and level of arousal to be
recorded on return to the ward followed by fourth hourly
for 24 hours if the patient is stable. Statistical analysis
Statistical analysis was carried out using SPSS version
Table 3: Experimental protocol
10. Descriptive statistics were calculated for all variables.
Temperature to be recorded on return to the ward then Chi-square analysis was undertaken to determine the
at the end of four hours followed by daily until discharge differences between the two groups. All patients who
if the patient is stable. Respiratory rate, pulse rate and were monitored could potentially have up to five vital
blood pressure to be monitored and recorded on return to signs outside normal limits. Therefore, the analysis was
the ward then one hourly for two hours followed by fourth performed on the number of occurrences of abnormal
hourly for 24 hours. Oxygen saturation and level of vital signs, rather than the number of patients. For
arousal to be monitored and recorded on return to the example, patients in the experimental group had two sets

Australian Journal of Advanced Nursing 17 2005 Volume 23 Number 1

 RESEARCH PAPER

of observations recorded in the first four hours following Two patients in the experimental group complained of
transfer to the ward. chest pain. The first patient, a 29 year old, complained of
chest pain seven hours after transfer and was treated with
Therefore the total number of potential abnormal vital
intravenous Ranitidine. The second patient, a 36 year old,
signs for this group of patients (n=93) would be 930, if all
had chest pain 15 hours after transfer, was treated with
parameters ie temperature, pulse, respiratory rate, blood
sublingual nitrates and cardiac investigations were
pressure and oxygen saturation were monitored at both
undertaken. The chest pain resolved within the hour in
times. As more frequent monitoring can result in an
increase in the detection of abnormal vital signs the both patients and they were discharged home the
proportion of the abnormal vital signs in each group was following day.
calculated. Five hours after returning to the ward one patient in the
control group tried to sit out of bed and fell. Vital signs
recorded at the time of the fall were stable and the patient
RESULTS
exhibited no signs or symptoms of complications,
Two hundred and twenty seven patients who met the although, the patient was asked to remain in bed for a
inclusion criteria were randomised to either group. further two hours, and was discharged home the next day.
However, 38 patients were subsequently excluded as they
were administered either spinal or local anaesthesia for Incidence of abnormal vital signs
the surgical procedure or were commenced on PCA The number of abnormal vital signs that were
following surgery. These results are therefore based on an documented has been reported in table 8. Ten patients in
analysis of 189 patients (experimental=93; control=96). the experimental group and five patients in the control
Forty-two of these patients were not monitored according group had a pulse rate of less than 60 beats/minute at
to the assigned protocol however their data have been baseline. When these patients data were removed from
included in an intention to treat analysis (table 5). the analysis there was no statistically significant
There were no significant differences between the difference in the number of abnormal vital signs at any
experimental and control groups in any of the baseline point in the first 24 hour period. Therefore the data from
characteristics (table 6), nor were there any statistically these patients were included in the final analysis.
significant differences in the observations recorded at Although monitoring the respiratory rate and oxygen
admission or in the recovery unit (table 7). saturation was a requirement of the protocol, these vital
The majority of patients had a general surgical signs were monitored in less than 70% of all patients.
procedure (n=151), whilst the other operations involved Abnormal events relating to these vital signs have,
the head and neck (including faciomaxillary) (n=3), ear, therefore, not been included in the final analysis. In those
nose and throat (n=1), orthopaedics (n=8), gynaecology patients who did have this vital observation monitored,
(n=14), urology (n=10), breast (n=1), and plastic surgery none had tachypnoea or bradypnoea in the 24 hour period
(n=1) (table 6). and only one patient had an abnormal oxygen saturation
(89%) on transfer to the ward. It could be postulated that
Incidence of adverse outcomes the low level of oxygen could be due to the fact that this
During their period of hospitalisation, none of the patient had a diagnosis of pulmonary embolism and was
patients in either group developed a postoperative transferred to the ward without oxygen therapy. Treatment
emergency that required management and treatment by an with oxygen supplementation for one hour resulted in the
intensive care team or transfer to the ICU/HDU. patient attaining normal oxygen saturation.

Table 5: Flow chart of patients through the study

Australian Journal of Advanced Nursing 18 2005 Volume 23 Number 1

 RESEARCH PAPER

Incidence of abnormal vital signs on transfer to Hyperthermia was recorded in one patient in the
the ward control group.
On their return to the ward from the recovery unit, all Incidence of abnormal vital signs in the first 24 hours
patients had their temperature, pulse, and blood pressure following transfer to the ward after surgery
monitored. However, the respiratory rate was monitored
In the 24 hours following transfer to the ward, patients
in only 28% and oxygen saturation was monitored in only
in the experimental group (n=93) had seven and those in
77% of patients, therefore these parameters were not
the control group (n=96) had six sets of observations
considered in the analysis. Twenty-one patients in the
recorded. Again these do not include the vital signs
experimental group and 17 patients in the control group
recorded at transfer. Therefore, the number of potential
had one untoward event each, however, these results were abnormal vital signs that could occur in the experimental
not statistically significant (p=0.44) (OR 1.30, 95% CI group and control group were 1953 and 1728 respectively.
0.67, 2.51) (table 8). The most commonly occurring
untoward events were bradycardia (n=18: 3.1%) followed One hundred and fourteen abnormal vital signs
by hypotension (n=11: 2%). (experimental=52; control=62) were identified in 65
patients (experimental=33; control=32) in the first 24
Incidence of abnormal vital signs in the first four hour period following transfer to the ward from the
hours following transfer to the ward recovery unit (p=0.11) (OR 0.74; 95% CI .51, 1.07) (table
8). These abnormal vital signs occurred at any time
In the first four hours after returning to the ward from
during the 24 hour postoperative period and not
the recovery unit, patients in the experimental group had
necessarily in the first four hours.
two sets of vital signs and those in the control group had
only one set of vital signs recorded (these do not include Hypotension (n=32) (0.9%) and bradycardia (n=46)
the vital signs recorded at transfer). Therefore, the (1.2%) were the most common untoward events
number of potential untoward events that could occur in documented (table 8). In the 20 patients who developed
the experimental group and control group was 558 and hypotension and 23 patients who developed bradycardia,
288 respectively. 14 had a low blood pressure and five had a low pulse rate
at baseline. Severe bradycardia (HR <50 beats/minute)
A total of 33 untoward events (experimental=21; was not identified in any of the patients in the first 24
control=12) were identified in 30 patients hours following surgery. None of the patients who had an
(experimental=18; control=12). These results were not abnormal blood pressure or pulse complained of
statistically significant (p=0.77) (OR 0.90; 95% CI 0.44, dizziness, nausea or weakness.
1.86) (table 8). Hypotension (n=12) (1.5%) and
bradycardia (n=11) (1.4%) were the most commonly All patients who developed untoward events were
occurring untoward event during this period. managed with appropriate nursing interventions and the
attending doctor was notified of the changes in vital
In the 12 patients who developed hypotension and signs. Assistance from the doctor was required in only
11 patients who developed bradycardia, six had a low three patients: two who developed chest pain and one who
blood pressure and three had a low pulse rate at baseline. had a fall.

Table 6: Patient demographics Table 7: Demographics

Experimental Control Experimental group Control group
group group Mean (Std. deviation) Mean (Std. deviation)
Total number of
patients analysed 93 96 Length of hospital stay 2 days (1.33) 1.8 days (1.36)
Males 44 41
Length of stay
Female 49 55 after surgery 1.92 days (1.34) 1.8 days (1.6 )
Age 53.98 (SD 17.53)
Range 20-85 years 48.23 (SD 16.45) Length of anaesthesia 83 minutes (37) 82 minutes (30)
Range 19-81 years
Length of surgery 63 minutes (33) 66 minutes (70)
Types of surgery
General surgery 74 77 Length of time in recovery 87 minutes (47.5) 84 minutes (43)
Head and neck
including faciomaxillary 1 2 Systolic blood pressure
Ear, nose and throat 1 at baseline 137 (27) 134.8 ( 22.2)
Breast 1
Diastolic blood pressure
Orthopaedics 3 5 at baseline 79.4 (11.7) 79.7 (13.3)
Gynaecology 8 6
Urology 5 5 Pulse rate at baseline 72 (11) 73.7 (11)
Plastic 0 1

Australian Journal of Advanced Nursing 19 2005 Volume 23 Number 1

 RESEARCH PAPER

Table 8: Incidence of abnormal vital signs

Time Vital sign Experimental group Control group p value Odds ratio (95% CI)
No. of abnormal vital signs (%) No. of abnormal vital signs (%)
Transfer Temperature >38 0 0
Bradycardia 13 5
Tachycardia 2 3
Hypotension 6 5
Hypertension 0 4
Total 21 (7.5%) 17 (6%) 0.44 1.30 (0.67, 2.51)
4 hours Temperature >38 2 1
Bradycardia 8 3
Tachycardia 4 2
Hypotension 7 5
Hypertension 0 0
Total 21 (3.8%) 12 (4.1%) 0.77 0.90 (0.44, 1.86)
24 hours Temperature >38 6 7
Bradycardia 24 22
Tachycardia 8 5
Hypotension 10 22
Hypertension 4 6
Total 52 (2.7%) 62 (3.6%) 0.11 0.74 (0.51, 1.07)

DISCUSSION (n=12) in the first four hours. This could be due to the
fact that patients in the experimental group were
Various regimes for monitoring vital signs in the monitored more frequently than those in the control
postoperative period have been used, although there is group, thus increasing the likelihood of detection of
limited documentation of research relating to this abnormal vital signs.
practice. This randomised controlled trial was undertaken
to compare the safety and efficacy of a modified protocol This study supports the findings of other researchers
to the usual hospital protocol for monitoring patients on (Harley and Tsamassiros 1997) that following return to
their return to the ward from the recovery unit. The the ward from the recovery unit if abnormal vital signs
experimental protocol was developed from the findings of have not occurred in the first two and a half hours it is
a systematic review, literature review of commonly unlikely they will occur within the first four hours. The
occurring complications in the first 24 hours following results also demonstrated no statistically significant
surgery and expert advice. difference in the incidence of abnormal vital signs in the
first 24 hours, thus supporting the feasibility and safety of
The major difference between the two monitoring reduced frequency of monitoring vital signs following a
regimes was the number of times the patients were patients return to the ward from the recovery unit.
monitored in the first four hours following return to the
ward from the recovery unit. Although all patients were In this study, the incidence of abnormal vital signs may
monitored on transfer, patients in the experimental group be underestimated due to poor compliance by nurses to
were monitored for a further two hours while patients in the monitoring schedules. Although the monitoring
the control group were monitored only once again in the regimes for both the experimental and control groups
following four hours. The main outcome of interest was included monitoring of the oxygen saturation, it was
the number of patients who required assistance of the interesting to note that this observation was monitored in
intensive care team or transfer to the intensive care unit. less than 80% of all patients. One would assume that the
Other outcomes assessed included the number of patients patients who did not have their oxygen saturation
who developed abnormal vital signs or had any adverse monitored would have their respiratory rate monitored.
complications, eg, haemorrhage. However, this was not the case as there were patients who
had neither observation recorded.
Patients frequently exhibit abnormal vital signs during
recovery from general anaesthesia and in only a minority In this study bradycardia and hypotension were the
of cases does this progress and require intervention. most commonly occurring abnormal vital signs in the
Therefore statistical analysis was undertaken on the first 24 hours which supports the findings of other
number of abnormal vital signs documented in each researchers. However, it should be noted that for the
group, rather than the number of patients who developed purpose of this study, bradycardia was defined as a pulse
the abnormal vital signs. rate of less than 60 beats/minute. The majority of the
patients who had bradycardia postoperatively also had a
The incidence of abnormal vital signs in the first 24
baseline pulse rate of under 60 beats/minute.
hours following return to the ward from the recovery unit
was 3%. Although not statistically significant, a greater The majority (78%) of abnormal vital signs occurred
number of abnormal vital signs (n=21) were identified in after the first four hours indicating that all patients
the experimental group compared to the control group following surgery are at risk, hence pertinent observations

Australian Journal of Advanced Nursing 20 2005 Volume 23 Number 1

 RESEARCH PAPER

are critical and nursing staff should be vigilant as postoperative period may in fact be more intensive than is
complications can occur at any point along the indicated by patient outcomes. The data presented fails to
postoperative continuum. provide justification for routine, frequent monitoring of
vital signs in the postoperative period following return to
None of the patients in either group demonstrated any
the ward from the recovery unit. However, the results
serious or potentially life threatening events after
cannot be generalised to all patients following surgery.
returning to the ward. In the three patients who developed
Clinicians, however, must utilise clinical judgement to
untoward events, there was no association between the
determine which patients require close monitoring during
time of occurrence of the abnormal vital sign, and the
time since return to the ward. the postoperative period. Further research needs to be
undertaken to assess patient satisfaction with reduced
These results indicate that there is no association monitoring.
between the frequency of observations in the first four
hours and outcomes for the type of patients included in
this study. However, as no adverse events were reported, it REFERENCES
is unclear whether monitoring the patient frequently in the Arsenault, C. 1998. Nurses guide to general anaesthesia, part 2. Nursing 98.
28(5):32.cc1-32cc5.
first four hours assists in the early identification of
patients at risk of postoperative complications. Bayne, C.G. 1997. Vital signs: Are we monitoring the right parameters?
Nursing Management. 28(5):74-6.
The results from this study have implications for Botti, M. and Hunt, J. 1994. The routine of post anaesthetic observations.
clinicians and administrators and provide a platform for Contemporary Nurse. 3(2):52-57.

the rational use of services aimed at optimising patient Burroughs, J. and Hoffbrand, B.I. 1990. A critical look at nursing observations.
Postgraduate Medical Journal. 66(779):370-2.
care post surgery. The regimes for postoperative
Centre for Applied Nursing Research. 1998. Postoperative observations. A
monitoring should be based upon the condition of the systematic review. Joanna Briggs Institute for Evidence Based Nursing and
patients, the nurses clinical judgement and with Midwifery: Adelaide.
consideration of existing guidelines within the facility. Davis, M.J. and Nomura, L.A. 1990. Vital signs of class 1 surgical patients.
Monitoring regimes should include appropriate vital signs Western Journal of Nursing Research. 12(1):28-41.

to identify the complications that have been commonly Evans, D., Hodgkinson, B. and Berry, J. 1999. Vital signs. A systematic review.
The Joanna Briggs Institute for Evidence Based Nursing and Midwifery:
reported to occur following surgery. Diligent visual Adelaide.
observation and communication with the patient is also Field, D. 1998. Assessment of haemostasis. Nursing Times. 94(29):54-6.
important as part of the patients postoperative care.
Gamil, M. and Fanning, A. 1991. The first 24 hours after surgery. A study of
complications after 2153 consecutive operations. Anaesthesia. 46(9):712-5.
Monitoring appropriate vital signs based on clinical
judgement will provide nursing staff with valuable time Harley, J. and Tsamassiros, J. 1997. A pilot study analysing the occurrence and
frequency of reoccurring vital signs outside of normal parameters and other
and added flexibility to prioritise other nursing abnormal symptoms exhibited in the postoperative phase of short term surgical
interventions. As the nurses role expands to include more patients. Unpublished.
assessments, planning, teaching and evaluation, it is Heidenreich, T. and Giuffre, M. 1990. Postoperative temperature measurement.
Nursing Research. 39(3):153-5.
imperative that clinical practice is based on evidence
rather than tradition. This research study reports on one Lee, A., Lum, M.E., ORegan, W.J. and Hillman, K.M. 1998. Early
postoperative emergencies requiring an intensive care team intervention: The
clinical practice that can be changed to achieve that goal. role of ASA physical status and after-hours surgery. Anaesthesia. 53(6):529-35.

A major limitation of the study is the sample size, Litwack, K. 1997. Practical points in the evaluation postoperative fever. Journal
of Perianesthesia Nursing. 12(2):100-4.
therefore the findings of this study cannot be generalised
Moller, J.T., Jensen, P.F., Johannessen, N.W. and Espersen, K. 1992.
beyond the population and setting where this study was Hypoxaemia is reduced by pulse oximetry monitoring in the operating theatre
conducted. Potential confounders of early postoperative and in the recovery room. British Journal of Anaesthesia. 68(2):146-50.
untoward events include the type of surgery, type of Moller, J.T., Johannessen, N.W., Espersen, K., Ravlo, O., Pedersen, B.D.,
Jensen, P.F., Rasmussen, N.H., Rasmussen, L.S., Pedersen, T., Cooper, J.B. et al.
anaesthesia and ASA classification of the patients. 1993. Randomized evaluation of pulse oximetry in 20,802 patients:
However, as all the patients in the study had general Perioperative events and postoperative complications. Anesthesiology.
anaesthesia and were classified as ASA class 1 or 2 and 78(3):445-53.
most of them had general surgery it can be concluded that Pett, S.B. Jr. and Wernly, J.A. 1988. Respiratory function in surgical patients:
Perioperative evaluation and management. Surgical Annuals. 20:311-29.
the findings are only applicable to this population and
Rosenberg, J., Dirkes, W.E. and Kehlet, H. 1989. Episodic arterial oxygen
cannot be generalised to other types of patients. desaturation and heart rate variations following major abdominal surgery.
British Journal of Anaesthesia. 63(6):651-4.
Replication of this study in other settings with patients
Thompson, P. 1983. Postoperative respiratory distress: Life or death. Journal of
classified as ASA 3 and with other surgical procedures Practical Nursing. 33(9):19-22.
will provide an evidence-based protocol for monitoring
Wipke-Tevis, D.D. 1999. Vascular infections: Medical and surgical therapies.
patients in the postoperative unit. Journal of Cardiovascular Nursing. 13(2):70-81.
Wolters, U., Wolf, T., Stutzer, H. and Schroder, T. 1996. ASA classification and
perioperative variables as predictors of postoperative outcome. British Journal
CONCLUSION of Anaesthesia. 77(2):217-222.
Zeitz, K. and McCutcheon, H. 2002. Policies that drive the nursing practice of
The research, including this study, demonstrates that postoperative observations. International Journal of Nursing Studies.
current regimens for monitoring patients in the immediate 39(8):831-839.

Australian Journal of Advanced Nursing 21 2005 Volume 23 Number 1