Relevance of the expression “ obs stabl e ” : a retrospective study
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Relevance of the expression “obs stable ” :
a retrospective studyGregory Scott Academic clinical fellow
Roshan Vijayan Core surgical trainee
Pandora Male Medical student
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Obs stable
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Serious and important
BMJ
Seriousness
Quite silly and not important Christmas
BMJ
Importance
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Should we seriously worry about what we write?
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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
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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
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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
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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)
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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%
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Results: all “stable” observations
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Results: 24 hourly range of “stable” observations
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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
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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
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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
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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.
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Thank you
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