Relevance of the expression “ obs stabl e ” : a retrospective study
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Transcript of Relevance of the expression “ obs stabl e ” : a retrospective study
Relevance of the expression “obs stable ” :
a retrospective studyGregory Scott Academic clinical fellow
Roshan Vijayan Core surgical trainee
Pandora Male Medical student
Obs stable
Serious and important
BMJ
Seriousness
Quite silly and not important Christmas
BMJ
Importance
Should we seriously worry about what we write?
What’s wrong with “obs stable”?
1. “Stable” might be interpreted as “normal”
ButA patient with persistent tachycardia
has “stable” observations
2. “Obs stable” implies a lack of rigour
What do we even mean by “stable”?
Current obs within “normal” range?
Variation in obs within “normal” limits (L) for a given time period (t)?
t
L
Study• Objective: To ascertain whether use of the term “obs
stable” is so liberal as to render it meaningless.• Design: Retrospective study • Setting: Three London hospitals • Methods
– Searched notes for current admission of 46 randomly selected inpatients for “obs stable” entries
– Reviewed the nursing observations recorded during the 24 hours preceding each entry
– Calculated for these 24 hour periods:• Frequency of any abnormalities• Frequency of persistent abnormalities (occurring in every
observation)• Range (max.-min.) of observation values if at least two
observations had been recorded
Results: “obs stable” occurrences
– 1+ “obs stable” entry in 36 (78%) notes – 178 “obs stable” entries total (3.9 per
patient)– 1st “obs stable” entry on day 2 (median) – 3.9 nursing observations charted in the
24 hours before each entry (SD 1.4)
Results: abnormalities in the 24 hours preceding “obs stable”
– 1+ abnormality in 113 (71%) of 159 cases• Tachypnoea (55%), hypotension (21%),
tachycardia (13%), desaturation (16%)– 1+ one persistent abnormality in 31
(19%) cases– Abnormality occurred in the
observations immediately preceding an entry in 42% DefinitionsHypotension = SBP <100mmHg, Tachycardia = HR >100/minPyrexia = temperature >38C, Tachypnoea = RR≥20/minOxygen desaturation = saturations <95%
Results: all “stable” observations
Results: 24 hourly range of “stable” observations
Discussion: findings• Doctors regularly used the expression “obs
stable”• “Obs stable” was often associated with a 24 hour
period which included abnormal observations• In two fifths of cases, an abnormality occurred in
the observations immediately preceding an “obs stable” entry
• The range of observations over a 24 hour period that were designated “stable” occasionally exceeded normal values of diurnal variation
Discussion: limitations• Small sample• No comparison with non-“stable” entries• Arbitrary definition of abnormalities• Arbitrary choice of 24 hour period• Difficult to define “normal” diurnal
variation
Discussion: why do we write“obs stable”?
• Lack of time given to documentation• Intended to be less committal• Observation chart design• The patient seems well
Conclusions• The meaning of “obs stable” is ambiguous
and does not always indicate normality.• What could we write instead?–Write the observations in full – Qualify “obs stable” by adding “for the last
X hours” or– “Last abnormal observation was X
[observation] at Y [time]”• Perhaps obs stable has become ubiquitous
precisely because it of its ambiguity.
Thank you