title: Vital signs and other observations used to detect deterioration in pregnant women: an analysis of vital sign charts in consultant-led UK maternity units.
abstract: BACKGROUND
  Obstetric early warning systems are recommended for monitoring hospitalised pregnant and postnatal women. We decided to compare: (i) vital sign values used to define physiological normality; (ii) symptoms and signs used to escalate care; (iii) type of chart used; and (iv) presence of explicit instructions for escalating care.
  
  
  METHODS
  One-hundred-and-twenty obstetric early warning charts and escalation protocols were obtained from consultant-led maternity units in the UK and Channel Islands. These data were extracted: values used to determine normality for each maternal vital sign; chart colour-coding; instructions following early warning system triggering; other criteria used as triggers.
  
  
  RESULTS
  There was considerable variation in the charts, warning systems and escalation protocols. Of 120 charts, 89.2% used colour; 69.2% used colour-coded escalation systems. Forty-one (34.2%) systems required the calculation of weighted scores. Seventy-five discrete combinations of 'normal' vital sign ranges were found, the most common being: heart rate=50-99beats/min; respiratory rate=11-20breaths/min; blood pressure, systolic=100-149mmHg, diastolic ≤89mmHg; SpO2=95-100%; temperature=36.0-37.9°C; and Alert-Voice-Pain-Unresponsive assessment=Alert. Most charts (90.8%) provided instructions about who to contact following triggering, but only 41.7% gave instructions about subsequent observation frequency.
  
  
  CONCLUSIONS
  The wide range of 'normal' vital sign values in different systems suggests a lack of equity in the processes for detecting deterioration and escalating care in hospitalised pregnant and postnatal women. Agreement regarding 'normal' vital sign ranges is urgently required and would assist the development of a standardised obstetric early warning system and chart.
authors.affiliation: Centre of Postgraduate Medical Research & Education (CoPMRE), Faculty of Health and Social Sciences, Bournemouth University, UK. Electronic address: gbsresearch@virginmedia.com.
authors.forename: G B
authors.initials: GB
authors.lastname: Smith
authors.affiliation: Centre of Postgraduate Medical Research & Education (CoPMRE), Faculty of Health and Social Sciences, Bournemouth University, UK; Department of Anaesthesia, Southampton University Hospital NHS Foundation Trust, Southampton, UK.
authors.forename: R
authors.initials: R
authors.lastname: Isaacs
authors.affiliation: Bournemouth University Clinical Research Unit (BUCRU), Faculty of Health and Social Sciences, Bournemouth, UK.
authors.forename: L
authors.initials: L
authors.lastname: Andrews
authors.affiliation: Centre of Postgraduate Medical Research & Education (CoPMRE), Faculty of Health and Social Sciences, Bournemouth University, UK; Department of Anaesthesia, Poole Hospital NHS Foundation Trust, Poole, UK.
authors.forename: M Y K
authors.initials: MYK
authors.lastname: Wee
authors.affiliation: Centre for Midwifery, Maternal & Perinatal Health, Faculty of Health and Social Sciences, Bournemouth University, UK.
authors.forename: E
authors.initials: E
authors.lastname: van Teijlingen
authors.affiliation: Centre for Midwifery, Maternal & Perinatal Health, Faculty of Health and Social Sciences, Bournemouth University, UK; Florence Nightingale Faculty of Nursing and Midwifery/Division of Women's Health, King's College, London, UK.
authors.forename: D E
authors.initials: DE
authors.lastname: Bick
authors.affiliation: Centre for Midwifery, Maternal & Perinatal Health, Faculty of Health and Social Sciences, Bournemouth University, UK.
authors.forename: V
authors.initials: V
authors.lastname: Hundley
mesh_terms: D000328:Adult; D042241:Early Diagnosis; D004632:Emergency Medical Services; D005260:Female; D006748:Hospital Departments / Q000706:statistics & numerical data*; D006760:Hospitalization; D006801:Humans; D061214:Patient Safety; D011247:Pregnancy; D011996:Records / Q000592:standards; D006113:United Kingdom; D055986:Vital Signs; D016387:Women's Health
keywords: Maternity; Obstetric emergency team; Patient safety; Standards of care; Trigger tools; Women’s health