The impact of a governmental policy prohibiting wearing of wristwatches on the measurement of pulse and respiratory rate

David Spitzer

Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK

Background: It is recommended that pulse and respiratory rates are measured accurately rather than estimated. The UK’s ‘bare below the elbow’ policy prohibiting hospital doctors from wearing wristwatches conflicts with this guidance.

Objective: To assess (a) whether pulse/respiratory rates are measured accurately or estimated, (b) adherence to the ‘bare below the elbow’ policy with regard to the wearing of wristwatches, and (c) if the policy has affected whether pulse/respiratory rates are measured or estimated.

Method: A questionnaire was distributed to 52 doctors (with a wide range of experience) working in medical and surgical wards, accident and emergency and the intensive care unit at the Homerton University Hospital, London, UK.

Results: Findings indicated that (a) there is wide variation of practice over whether pulse/respiratory rates are measured accurately or estimated, (b) doctors generally adhere to instructions not to wear wristwatches, and (c) a majority of doctors indicate that the ‘bare below the elbow’ policy has affected their behavior with regard to measurement of pulse and respiratory rate.

Conclusions: If the importance of accurate measurement of pulse/respiratory rate is accepted, these findings suggest that doctors be provided with watches which they can attach to other parts of their clothing or neck fobs. Although not ideal, this solution provides a way of resolving the conflict between the ‘bare below the elbow’ policy and accurate measurement of pulse and respiratory rate.

Keywords: pulse, respiratory rate, measurement, governmental policy, bare below the elbow, dress code, wristwatch, clinical audit