How to detect the subtle changes of early deterioration

Presently, nursing staff in veterinary hospital wards often monitor their patients through measurements of simple variables such as temperature, respiratory rate, and heart rate through intermittent observations. According to Aldridge and O'Dwyer (2013) the ability to quickly and accurately detect clinical deterioration in a patient during these assessments is an essential nursing skill set for safe, quality care and for improving patient outcomes. Therefore, nurses should not only be able to detect subtle changes of early deterioration, but should also respond timely and appropriately.

Close monitoring is vital to recognising changes that are indicative of patient deterioration. It allows time for intervention to avert an impending crisis. Instead of using a single one-off measurement, observing a ‘pattern’ in the monitored vital sign gives the most relevant information (Aldridge and O'Dwyer, 2013). It is essential to accurately record these findings in order to easily monitor an ongoing trend (see Figure 1). The possible complications, the individual patient, the perceived risk of deterioration, and the severity of the problem, which can all be documented on the animal's treatment plan, will determine the rate at which these parameters are monitored (Humm and Kellett-Gregory, 2016). Rather than performing more complex tests that require a longer time to complete, it should be noted that repeated re-examination of some important ‘basic’ parameters may be more effective in identifying early deterioration (Aldridge and O'Dwyer, 2013). More specific monitoring, such as lactate levels, blood gases, clotting times, and electrocardiography can be conducted when specific problems are observed through physical examination.