Baseline physiological observations
Measure and record temperature, respiratory rate, pulse, blood pressure, oxygen saturations and urine output.
Do it yourself on a patient, with support available if you need it — the GMC’s highest new-grad level (“indirect supervision”).
Overview
The foundation of recognising the deteriorating patient. Six parameters feed NEWS2 — respiratory rate, SpO₂, systolic BP, pulse, consciousness/new confusion (ACVPU) and temperature — uplifted by 2 for supplemental oxygen. Accurate obs, correctly recorded and *escalated*, are the first link in every acute chain.
Key numbers
- NEWS2 escalation: aggregate ≥5 (or 3 in any single parameter) = urgent review; ≥7 = emergency, consider critical careRCP NEWS2
- Add 2 to the score for any supplemental oxygen; use SpO₂ Scale 2 (target 88–92%) for hypercapnic-risk patientsRCP NEWS2
Indications
- Routine monitoring of every inpatient
- Assessing an acutely unwell or deteriorating patient
- Baseline before/after a procedure, drug or transfusion
- Triage and track-and-trigger (NEWS2)
Equipment
Step by step
- 1Wash hands, introduce yourself, confirm patient identity and gain consent
- 2Ensure the patient is rested and comfortable
- 1Respiratory rate — count for a full 60 seconds while appearing to take the pulse (so it stays unconscious/accurate)
- 2Oxygen saturations — probe on a warm finger; note if on air or O₂ (and how much)
- 3Pulse — rate, rhythm and character for 60 seconds
- 4Blood pressure — correct cuff at heart level; note lying/standing if postural symptoms
- 5Temperature
- 6Level of consciousness — ACVPU (Alert / Confusion (new) / Voice / Pain / Unresponsive)
- 1Document each value on the NEWS2 chart and calculate the aggregate score
- 2Escalate per the NEWS2 threshold (e.g. NEWS ≥5 = urgent senior review)
- 3Repeat at a frequency matched to the score/clinical concern
OSCE tips
- Respiratory rate is the most sensitive early sign of deterioration — and the one most often fudged. Count it properly.
- A NEWS2 of 3 in a *single* parameter still triggers review — not just the aggregate.
- Add 2 to NEWS2 for any supplemental oxygen.
- State your escalation plan out loud (who you’d call and when) — examiners reward safety-netting.
Read
Sources & credits
Authored to UK finals standard and verified against UK guidance (RCP NEWS2) and Geeky Medics OSCE guides . Southampton teaching materials © University of Southampton. Always follow current local policy.