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BMJ. 2008 January 5; 336(7634): 10.
PMCID: PMC2174728
“Bare below the elbows”

Clinical value of a wristwatch

James Henderson, SpR plastic surgery1 and Sarah McCracken, SpR geriatric medicine2

Trusts are about to implement a “bare below the elbows” dress code policy for doctors. This includes the banishing of wristwatches from “clinical areas.”1 2 There is no evidence that wristwatches are carriers of infection. It has been proposed, but not shown, that watches may impair handwashing.1 Little account has been made of the clinical benefits of a wristwatch. Most beds and examination couches in hospitals do not currently allow sight of a clock.

Twenty appropriately trained healthcare staff were assessed for their ability to carry out basic clinical observations without the use of a second hand, to assess the dependence placed on wristwatches. Nine senior medical students, six junior doctors, one consultant, and four trained nurses were asked to evaluate heart rate (pulse) and respiratory rate on the Laerdal Sim Man simulated patient. Each participant was assessed at regular pulse rates of 83, 36, and 168 beats per minute and respiratory rates of 14, 30, and 4 breaths per minute. Participants were given as much time as they wanted to make their estimate.

Every participant took longer than one minute to make each estimate. All participants would have failed an undergraduate objective structured clinical examination (OSCE) station, and only one participant gave values for each reading that would not have been potentially dangerous in a clinical setting. Estimates for a pulse rate of 83 ranged from 60 to 120, and estimates for a respiratory rate of 14 ranged from 10 to 28, which shows that it was often not possible for healthcare professionals even to distinguish normal from abnormal without the use of a second hand.

This study highlights the necessity for doctors to have sight of a second hand when assessing patients, especially in emergency situations where a clock might not be present. A pilot study by the lead author of removing his own wristwatch had to be abandoned after one day because of consistent lateness.

Fob watches have been found to be impractical for some clinical procedures.3 If trusts wish to persist with the banning of wristwatches, they will be obliged to provide each bedspace with its own clock with a second hand. The same department of health guidelines commend the wearing of soft soled shoes to avoid “disturbing patients’ rest.”1 The sound of a thousand clocks ticking might be rather more than a little disturbing.

Notes

Competing interests: JH likes to wear a wristwatch.

References

1. Hartley JC, Mackay AD, Scott GM. Wrist watches must be removed before washing hands. BMJ 1999;318:328a
2. Jacob G. Department of Health. Guidelines: Uniforms and workwear: an evidence base for developing local policy 2007. www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_078433
3. Nevill M, Ikeda M. Watch out for infection control. Br J Infect Contr 2006;7:12

Articles from The BMJ are provided here courtesy of BMJ Publishing Group