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Keywords:

  • decision-making;
  • deteriorating patient;
  • patient assessment;
  • patient safety;
  • risk management

Aims and objectives

To argue that if all nurses were to adopt the primary survey approach (assessment of airway, breathing, circulation and disability) as the first element of patient assessment, they would be more focused on active detection of clinical deterioration rather than passive collection of patient data.

Background

Nurses are the professional group that carry the highest level of responsibility for patient assessment, accurate data collection and interpretation. The timely recognition of, and response to deteriorating patients, is dependent on the measurement and interpretation of pertinent physiological data by nurses.

Design

Discursive paper.

Methods

Traditionally taught and commonly used approaches to patient assessment such as ‘vital signs’ and ‘body systems’ are not evidence-based nor framed in patient safety. The primary survey approach as the first element in patient assessment has three major advantages: (1) data are collected according to clinical importance; (2) data are collected using the same framework as most organisation's rapid response system activation criteria; and (3) the primary survey acts as a patient safety checklist, thereby decreasing the risk of failure to recognise, and therefore respond to, deteriorating patients.

Conclusion

The vital signs and body systems approaches to patient assessment have significant limitations in identifying clinical deterioration. The primary survey approach provides nurses with a consistent, evidence-based and sequenced approach to patient assessment in every clinical setting.

Relevance to clinical practice

All nurses should use a primary survey approach as the first element of patient assessment in every patient encounter as a patient safety strategy.