Nurse Led Vital Signs Monitoring Reduction Protocol
Care Process & Redesign
National University Health System Quality Improvement
National University Health System
25 March 2026
To implement a nurse-led protocol in NTFGH inpatient wards that empowers nurses to safely transition clinically stable. It is important to engage spread leaders early in the project to ensure stakeholders buy-in, and to maintain constant communication to.
Year Submitted: 2025
Published Date: 25 March 2026
Tags: Inpatient Care, Care Process ＆ Redesign, Operational Management, Resource Allocation, Productivity, Time Saving, Quality Improvement, Clinical Practice Improvement, Value Based Care, Safe Care
About this Content
Aims
To implement a nurse-led protocol in NTFGH inpatient wards that empowers nurses to safely transition clinically stable patients from 4 hourly to 8 hourly vital signs monitoring, aiming for 20% of patients to be on 8 hourly monitoring without any adverse events.
Background
There is currently no standardized guideline in NTFGH to determine the appropriate frequency of vital signs monitoring based on patient stability. 75% of inpatients are on 4 hourly vital signs monitoring, even though some are clinically stable, while only 4% are on 8 hourly monitoring. On average, each ward spends 817 minutes/day on vital checks. This highlights a significant opportunity to optimize monitoring frequency without compromising patient safety, thereby reducing unnecessary nursing workload, minimizing disturbances to patients, and improving resource utilization.
Methods
Development of nurse-led vital signs monitoring reduction protocol using NEWS2 score as reference guide, PDSA cycles with progressive scale-up from two pilot wards (B9S and C9) to all NTFGH inpatient wards, time motion study to quantify workload, focus group discussions to identify barriers, ward champion identification, standardized timing for protocol review during AM-PM shift handover, and audits at 6 months and 1 year post-implementation.
Results
Average time taken to complete one set of vital signs check = 3 minutes
Average time spent on vital signs check per ward = 817 minutes/day
Potential time saved from vitals reduction from Q4H to Q8H monitoring = 9 minutes/day/patient
Initial protocol compliance rate was 58.6%, improved after implementing feedback-based measures
No adverse events reported during implementation
Protocol successfully rolled out across all NTFGH inpatient wards
Lessons Learnt
It is important to engage spread leaders early in the project to ensure stakeholders buy-in, and to maintain constant communication to ensure successful change adoption. Protocol criteria needed refinement based on nurse feedback to ensure safety and ease of application. Standardized timing for review and increased awareness among both nurses and doctors were crucial for successful implementation.
Keywords
vital signs, NEWS2 score, nurse-led protocol, monitoring frequency, patient safety, workload reduction
Innovators' Details
Innovators' Details
Healthcare Cluster(s) | National University Health System |
Organization(s) Involved | Ng Teng Fong General Hospital |
Platform(s) | National University Health System Quality Improvement |
Healthcare Professional Group(s) | Medical, Nursing |
Applicable Specialty or Discipline | Operations, General Medicine, Nursing Research |
Project Lead(s) | Tan Mei Hong |
Project Member(s) | Audrey Chia |
Connect with this contributor!
Tan Mei Hong - mei_hong_tan@nuhs.edu.sg