Ensuring a proactive, evidence-based, patient safety approach to patient assessment
Article first published online: 18 JUN 2014
© 2014 John Wiley & Sons Ltd
Journal of Clinical Nursing
Volume 24, Issue 1-2, pages 300–307, January 2015
How to Cite
Considine, J. and Currey, J. (2015), Ensuring a proactive, evidence-based, patient safety approach to patient assessment. Journal of Clinical Nursing, 24: 300–307. doi: 10.1111/jocn.12641
- Issue published online: 23 DEC 2014
- Article first published online: 18 JUN 2014
- Manuscript Accepted: 5 MAY 2014
- 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.
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.
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.
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.