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An observational study of monitoring of vital signs in children admitted to Kenyan hospitals: an insight into the quality of nursing care?
Measurement and correct interpretation of vital signs is part of routine clinical care. Repeated measurement enhances early recognition of deterioration, may help prevent morbidity and mortality and is a standard of care in most countries. To examine documentation of vital signs by clinicians for ad...
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| Published in: | Journal of global health 2018-06, Vol.8 (1), p.010409-010409 |
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| creator | Ogero, Morris Ayieko, Philip Makone, Boniface Julius, Thomas Malla, Lucas Oliwa, Jacquie Irimu, Grace English, Mike |
| description | Measurement and correct interpretation of vital signs is part of routine clinical care. Repeated measurement enhances early recognition of deterioration, may help prevent morbidity and mortality and is a standard of care in most countries.
To examine documentation of vital signs by clinicians for admissions to paediatric wards in Kenyan hospitals, to describe monitoring frequency by nurses and explore factors influencing frequency.
Vital signs information (temperature, respiratory and pulse rate) for the first 48 hours of admission was collected from case records of children admitted with non-surgical conditions to 13 Kenyan county hospitals between September 2013 and April 2016. A mixed effect negative binomial regression model was used to explore whether the severity of illness (indicated by danger signs or severe diagnostic episodes) is associated with increased vital signs observation frequency.
We examined 54 800 admission episodes with an overall mortality 6.1%. Nurse to bed ratios were very low (1:10 to 1:41 across hospitals). Admitting clinicians documented all or no vital signs in 57.0% and 8.4% cases respectively. For respiratory and pulse rates there was pronounced even end-digit preference (an indicator of incorrect information) and high frequency recording of specific values (
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| doi_str_mv | 10.7189/jogh.08.010409 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_5826085</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2026401503</sourcerecordid><originalsourceid>FETCH-LOGICAL-c418t-f305ccb2a23ea0222515831e235b9984fc68b25b5d53636d9ac132b77aa8620b3</originalsourceid><addsrcrecordid>eNpdkU1vGyEQhlGVqoncXHuMkHLJxS4fCws5tLKiJq0aqZf2jFiW9WLtggOsJf-F_OqydWK15TKM5pkXZl4APmC0qrGQH7dh06-QWCGMKiTfgAuCqnpJpOBnp3stzsFlSltUTo0pEfwdOCeykjVD1QV4XnsYmmTjXmcXvB5gylN7gKGDY_Auh-j8Zs72Ls9Ft_EJOg9N74Y2Wg91O7qcbQtzgN-tP2gP-5B2M51uYcmcL019LrEQubfwadKDy3-e8FNMs77R0X5-D952pclevsQF-HX_5efd1-Xjj4dvd-vHpamwyMuOImZMQzShViNCCMNMUGwJZY2UouoMFw1hDWsZ5ZS3UpsydlPXWgtOUEMX4NNRdzc1o22N9TnqQe2iG3U8qKCd-rfiXa82Ya-YIBwJVgRuXgRieJpsymp0ydhh0N6GKSlS_KBc4rLuBbj-D92GKZY1zxThFcIM0UKtjpSJIaVou9NnMFKz02p2WiGhjk6Xhqu_Rzjhr77S39zZps4</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2026401503</pqid></control><display><type>article</type><title>An observational study of monitoring of vital signs in children admitted to Kenyan hospitals: an insight into the quality of nursing care?</title><source>Publicly Available Content Database</source><source>PubMed Central</source><creator>Ogero, Morris ; Ayieko, Philip ; Makone, Boniface ; Julius, Thomas ; Malla, Lucas ; Oliwa, Jacquie ; Irimu, Grace ; English, Mike</creator><creatorcontrib>Ogero, Morris ; Ayieko, Philip ; Makone, Boniface ; Julius, Thomas ; Malla, Lucas ; Oliwa, Jacquie ; Irimu, Grace ; English, Mike ; Clinical Information Network author group</creatorcontrib><description>Measurement and correct interpretation of vital signs is part of routine clinical care. Repeated measurement enhances early recognition of deterioration, may help prevent morbidity and mortality and is a standard of care in most countries.
To examine documentation of vital signs by clinicians for admissions to paediatric wards in Kenyan hospitals, to describe monitoring frequency by nurses and explore factors influencing frequency.
Vital signs information (temperature, respiratory and pulse rate) for the first 48 hours of admission was collected from case records of children admitted with non-surgical conditions to 13 Kenyan county hospitals between September 2013 and April 2016. A mixed effect negative binomial regression model was used to explore whether the severity of illness (indicated by danger signs or severe diagnostic episodes) is associated with increased vital signs observation frequency.
We examined 54 800 admission episodes with an overall mortality 6.1%. Nurse to bed ratios were very low (1:10 to 1:41 across hospitals). Admitting clinicians documented all or no vital signs in 57.0% and 8.4% cases respectively. For respiratory and pulse rates there was pronounced even end-digit preference (an indicator of incorrect information) and high frequency recording of specific values (
< 0.001) suggesting approximation. Monitoring frequency was explored in 41 738 children. Those with inpatient stays ≥48 hours were expected to have a vital signs count of 18, hospitals varied but most did not achieve this benchmark (median 9, range 2-30). There were clinically small but significant associations between vital signs count and presence of multiple severe illnesses or presence of severe pallor (adjusted relative risk ratio = 1.04,
< 0.01, 95% confidence interval CI = 1.02-1.06 and 1.05,
= 0.02, 95% CI = 1.01-1.09, respectively).
Data suggest accurate admission measures are sometimes missing especially for pulse and respiratory rates, possibly linked to manual measurement. Monitoring frequency is often low in the high risk population studied probably indicating how quality of nursing care is undermined by considerable human resource shortages.</description><identifier>ISSN: 2047-2978</identifier><identifier>EISSN: 2047-2986</identifier><identifier>DOI: 10.7189/jogh.08.010409</identifier><identifier>PMID: 29497504</identifier><language>eng</language><publisher>Scotland: Edinburgh University Global Health Society</publisher><subject>Body Temperature ; Child, Preschool ; Documentation - statistics & numerical data ; Female ; Global health ; Heart Rate ; Hospitals - statistics & numerical data ; Humans ; Infant ; Kenya ; Male ; Medical records ; Mortality ; Nursing care ; Nursing Care - standards ; Observational studies ; Patient Admission ; Pediatrics ; Quality of Health Care ; Respiratory Rate ; Studies ; Vital Signs</subject><ispartof>Journal of global health, 2018-06, Vol.8 (1), p.010409-010409</ispartof><rights>Copyright © 2018 by the Journal of Global Health. All rights reserved. This work is licensed under the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/3.0/ ) (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Copyright © 2018 by the Journal of Global Health. All rights reserved. 2018</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c418t-f305ccb2a23ea0222515831e235b9984fc68b25b5d53636d9ac132b77aa8620b3</citedby><cites>FETCH-LOGICAL-c418t-f305ccb2a23ea0222515831e235b9984fc68b25b5d53636d9ac132b77aa8620b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/2026401503/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2026401503?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,25753,27924,27925,37012,37013,44590,53791,53793,75126</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29497504$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ogero, Morris</creatorcontrib><creatorcontrib>Ayieko, Philip</creatorcontrib><creatorcontrib>Makone, Boniface</creatorcontrib><creatorcontrib>Julius, Thomas</creatorcontrib><creatorcontrib>Malla, Lucas</creatorcontrib><creatorcontrib>Oliwa, Jacquie</creatorcontrib><creatorcontrib>Irimu, Grace</creatorcontrib><creatorcontrib>English, Mike</creatorcontrib><creatorcontrib>Clinical Information Network author group</creatorcontrib><title>An observational study of monitoring of vital signs in children admitted to Kenyan hospitals: an insight into the quality of nursing care?</title><title>Journal of global health</title><addtitle>J Glob Health</addtitle><description>Measurement and correct interpretation of vital signs is part of routine clinical care. Repeated measurement enhances early recognition of deterioration, may help prevent morbidity and mortality and is a standard of care in most countries.
To examine documentation of vital signs by clinicians for admissions to paediatric wards in Kenyan hospitals, to describe monitoring frequency by nurses and explore factors influencing frequency.
Vital signs information (temperature, respiratory and pulse rate) for the first 48 hours of admission was collected from case records of children admitted with non-surgical conditions to 13 Kenyan county hospitals between September 2013 and April 2016. A mixed effect negative binomial regression model was used to explore whether the severity of illness (indicated by danger signs or severe diagnostic episodes) is associated with increased vital signs observation frequency.
We examined 54 800 admission episodes with an overall mortality 6.1%. Nurse to bed ratios were very low (1:10 to 1:41 across hospitals). Admitting clinicians documented all or no vital signs in 57.0% and 8.4% cases respectively. For respiratory and pulse rates there was pronounced even end-digit preference (an indicator of incorrect information) and high frequency recording of specific values (
< 0.001) suggesting approximation. Monitoring frequency was explored in 41 738 children. Those with inpatient stays ≥48 hours were expected to have a vital signs count of 18, hospitals varied but most did not achieve this benchmark (median 9, range 2-30). There were clinically small but significant associations between vital signs count and presence of multiple severe illnesses or presence of severe pallor (adjusted relative risk ratio = 1.04,
< 0.01, 95% confidence interval CI = 1.02-1.06 and 1.05,
= 0.02, 95% CI = 1.01-1.09, respectively).
Data suggest accurate admission measures are sometimes missing especially for pulse and respiratory rates, possibly linked to manual measurement. Monitoring frequency is often low in the high risk population studied probably indicating how quality of nursing care is undermined by considerable human resource shortages.</description><subject>Body Temperature</subject><subject>Child, Preschool</subject><subject>Documentation - statistics & numerical data</subject><subject>Female</subject><subject>Global health</subject><subject>Heart Rate</subject><subject>Hospitals - statistics & numerical data</subject><subject>Humans</subject><subject>Infant</subject><subject>Kenya</subject><subject>Male</subject><subject>Medical records</subject><subject>Mortality</subject><subject>Nursing care</subject><subject>Nursing Care - standards</subject><subject>Observational studies</subject><subject>Patient Admission</subject><subject>Pediatrics</subject><subject>Quality of Health Care</subject><subject>Respiratory Rate</subject><subject>Studies</subject><subject>Vital Signs</subject><issn>2047-2978</issn><issn>2047-2986</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><recordid>eNpdkU1vGyEQhlGVqoncXHuMkHLJxS4fCws5tLKiJq0aqZf2jFiW9WLtggOsJf-F_OqydWK15TKM5pkXZl4APmC0qrGQH7dh06-QWCGMKiTfgAuCqnpJpOBnp3stzsFlSltUTo0pEfwdOCeykjVD1QV4XnsYmmTjXmcXvB5gylN7gKGDY_Auh-j8Zs72Ls9Ft_EJOg9N74Y2Wg91O7qcbQtzgN-tP2gP-5B2M51uYcmcL019LrEQubfwadKDy3-e8FNMs77R0X5-D952pclevsQF-HX_5efd1-Xjj4dvd-vHpamwyMuOImZMQzShViNCCMNMUGwJZY2UouoMFw1hDWsZ5ZS3UpsydlPXWgtOUEMX4NNRdzc1o22N9TnqQe2iG3U8qKCd-rfiXa82Ya-YIBwJVgRuXgRieJpsymp0ydhh0N6GKSlS_KBc4rLuBbj-D92GKZY1zxThFcIM0UKtjpSJIaVou9NnMFKz02p2WiGhjk6Xhqu_Rzjhr77S39zZps4</recordid><startdate>20180601</startdate><enddate>20180601</enddate><creator>Ogero, Morris</creator><creator>Ayieko, Philip</creator><creator>Makone, Boniface</creator><creator>Julius, Thomas</creator><creator>Malla, Lucas</creator><creator>Oliwa, Jacquie</creator><creator>Irimu, Grace</creator><creator>English, Mike</creator><general>Edinburgh University Global Health Society</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>EHMNL</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20180601</creationdate><title>An observational study of monitoring of vital signs in children admitted to Kenyan hospitals: an insight into the quality of nursing care?</title><author>Ogero, Morris ; Ayieko, Philip ; Makone, Boniface ; Julius, Thomas ; Malla, Lucas ; Oliwa, Jacquie ; Irimu, Grace ; English, Mike</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c418t-f305ccb2a23ea0222515831e235b9984fc68b25b5d53636d9ac132b77aa8620b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Body Temperature</topic><topic>Child, Preschool</topic><topic>Documentation - statistics & numerical data</topic><topic>Female</topic><topic>Global health</topic><topic>Heart Rate</topic><topic>Hospitals - statistics & numerical data</topic><topic>Humans</topic><topic>Infant</topic><topic>Kenya</topic><topic>Male</topic><topic>Medical records</topic><topic>Mortality</topic><topic>Nursing care</topic><topic>Nursing Care - standards</topic><topic>Observational studies</topic><topic>Patient Admission</topic><topic>Pediatrics</topic><topic>Quality of Health Care</topic><topic>Respiratory Rate</topic><topic>Studies</topic><topic>Vital Signs</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ogero, Morris</creatorcontrib><creatorcontrib>Ayieko, Philip</creatorcontrib><creatorcontrib>Makone, Boniface</creatorcontrib><creatorcontrib>Julius, Thomas</creatorcontrib><creatorcontrib>Malla, Lucas</creatorcontrib><creatorcontrib>Oliwa, Jacquie</creatorcontrib><creatorcontrib>Irimu, Grace</creatorcontrib><creatorcontrib>English, Mike</creatorcontrib><creatorcontrib>Clinical Information Network author group</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>UK & Ireland Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of global health</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ogero, Morris</au><au>Ayieko, Philip</au><au>Makone, Boniface</au><au>Julius, Thomas</au><au>Malla, Lucas</au><au>Oliwa, Jacquie</au><au>Irimu, Grace</au><au>English, Mike</au><aucorp>Clinical Information Network author group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>An observational study of monitoring of vital signs in children admitted to Kenyan hospitals: an insight into the quality of nursing care?</atitle><jtitle>Journal of global health</jtitle><addtitle>J Glob Health</addtitle><date>2018-06-01</date><risdate>2018</risdate><volume>8</volume><issue>1</issue><spage>010409</spage><epage>010409</epage><pages>010409-010409</pages><issn>2047-2978</issn><eissn>2047-2986</eissn><abstract>Measurement and correct interpretation of vital signs is part of routine clinical care. Repeated measurement enhances early recognition of deterioration, may help prevent morbidity and mortality and is a standard of care in most countries.
To examine documentation of vital signs by clinicians for admissions to paediatric wards in Kenyan hospitals, to describe monitoring frequency by nurses and explore factors influencing frequency.
Vital signs information (temperature, respiratory and pulse rate) for the first 48 hours of admission was collected from case records of children admitted with non-surgical conditions to 13 Kenyan county hospitals between September 2013 and April 2016. A mixed effect negative binomial regression model was used to explore whether the severity of illness (indicated by danger signs or severe diagnostic episodes) is associated with increased vital signs observation frequency.
We examined 54 800 admission episodes with an overall mortality 6.1%. Nurse to bed ratios were very low (1:10 to 1:41 across hospitals). Admitting clinicians documented all or no vital signs in 57.0% and 8.4% cases respectively. For respiratory and pulse rates there was pronounced even end-digit preference (an indicator of incorrect information) and high frequency recording of specific values (
< 0.001) suggesting approximation. Monitoring frequency was explored in 41 738 children. Those with inpatient stays ≥48 hours were expected to have a vital signs count of 18, hospitals varied but most did not achieve this benchmark (median 9, range 2-30). There were clinically small but significant associations between vital signs count and presence of multiple severe illnesses or presence of severe pallor (adjusted relative risk ratio = 1.04,
< 0.01, 95% confidence interval CI = 1.02-1.06 and 1.05,
= 0.02, 95% CI = 1.01-1.09, respectively).
Data suggest accurate admission measures are sometimes missing especially for pulse and respiratory rates, possibly linked to manual measurement. Monitoring frequency is often low in the high risk population studied probably indicating how quality of nursing care is undermined by considerable human resource shortages.</abstract><cop>Scotland</cop><pub>Edinburgh University Global Health Society</pub><pmid>29497504</pmid><doi>10.7189/jogh.08.010409</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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| source | Publicly Available Content Database; PubMed Central |
| subjects | Body Temperature Child, Preschool Documentation - statistics & numerical data Female Global health Heart Rate Hospitals - statistics & numerical data Humans Infant Kenya Male Medical records Mortality Nursing care Nursing Care - standards Observational studies Patient Admission Pediatrics Quality of Health Care Respiratory Rate Studies Vital Signs |
| title | An observational study of monitoring of vital signs in children admitted to Kenyan hospitals: an insight into the quality of nursing care? |
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