CHS19.2012 Undertake routine clinical measurements

Overview

This standard covers taking and recording routine clinical measurements to establish a baseline for future comparison or as part of the individual’s care plan. The recording of such measurements must take into account the individual’s overall condition. It is important that where you have any concerns regarding your ability to correctly take these clinical measurements, or if you are at all unsure of your readings, you must ask another competent member of staff to check your recordings to ensure the correct actions can be instigated without delay. These activities could be done in a variety of care settings, including hospital wards and other departments including out patients, nursing homes, the individuals own home and GP surgeries. Users of this competence will need to ensure that practice reflects up to date information and policies. Version No 2

Knowledge and Understanding

You need to know and understand:

1. the current European and National legislation, national guidelines, organisational policies and protocols in accordance with any Clinical/Corporate Governance which affect your work practice in relation to undertaking routine clinical measurements
2. your responsibilities and accountability in relation to the current European and National legislation, national guidelines and local policies and protocols and any Clinical/Corporate Governance
3. the duty to report any acts or omissions in care that could be detrimental to yourself, other individuals or your employer
4. the importance of applying standard precautions to undertaking physiological measurements and the potential consequences of poor practice
5. the importance of working within your own sphere of competence and seeking clinical advice when faced with situations outside your sphere of competence
6. what valid consent means and why it must be obtained and confirmed prior to actions being taken
7. why the clinical measurements are necessary and the importance of undertaking them as directed
8. why it is necessary to adjust clothing and/or reposition the individual for some clinical measurements
9. the concerns and worries which individuals or client groups may have in relation to some clinical procedures
10. the equipment used for different measurements
11. any alternative equipment available
12. the importance of ensuring equipment is appropriately prepared
13. common conditions which necessitate the recording of physiological measurements within your work environment
14. how blood pressure is maintained
15. the differentiation between systolic and diastolic blood pressure and what is happening to the heart in each reading
16. the normal limits of blood pressure
17. conditions where blood pressure may be high or low
18. how body temperature is maintained
19. what normal body temperature is
20. what is meant by pyrexia, hyper-pyrexia and hypothermia
21. what is normal respiratory rate
22. what affects respiratory rates in individuals who are ill and well
23. the normal limits of pulse rates
24. what affects pulse rates – raising it and lowering it
25. the sites in the body where pulse points can be found
26. why an individual’s pulse oximetry needs to be measured
27. the findings when obtaining pulse oximetry, and the implications of these findings
28. what BMI is and how it is used in weight/dietary control
29. the factors that influence changes in clinical measurements
30. the importance of recording all information clearly and precisely in the relevant documentation, including whether the individual is receiving oxygen
31. the importance of reporting all information and any issues which are outside your own sphere of competence to the relevant member of staff without delay

Performance Criteria

You must be able to:

1. apply standard precautions for infection prevention and control and apply other necessary health and safety measures
2. check the individual’s identity and confirm the planned action
3. give the individual relevant information, support and reassurance in a manner which is sensitive to their needs and concerns
4. gain valid consent to carry out the planned measurement
5. take the measurement at the prescribed time and in the prescribed sequence
6. use the appropriate equipment in such a way as to obtain an accurate measurement
7. reassure the individual throughout the measurement and answer questions and concerns form the individual clearly, accurately and concisely within own sphere of competence and responsibility
8. refer any questions and concerns from or about the individual relating to issues outside your responsibility to the appropriate member of the care team
9. seek a further recording of the measurement by another staff member if you are unable to obtain the reading or if you are unsure of the reading
10. observe the condition of the individual throughout the measurement
11. identify and respond immediately in the case of any significant changes in the individual’s condition
12. recognise and report without delay any measurement which falls outside of normal levels
13. record your findings accurately and legibly in the appropriate documentation
14. clean used equipment and return to usual place of storage after use
15. dispose of waste and disposable equipment appropriately

Additional Information

This standard links with the following dimension within the NHS Knowledge and Skills Framework (October 2004): Dimension: HWB6 Assessment and treatment planning