Pre‐procedure

ActionRationale

1. 1.Show
   Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed.
   To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [144], C).
2. 2.Show
   Decontaminate hands with soap and water and/or an alcohol‐based handrub, and apply personal protective equipment.
   To prevent cross‐infection (NHS England and NHSI [124], C).
3. 3.Show
   Where possible, measure the pulse under the same conditions each time.
   To ensure continuity and consistency in recording (Tait et al. [194], E).
4. 4.Show
   Ensure that the patient is comfortable and relaxed. Ideally the patient should refrain from physical activity for 20 minutes before their pulse is measured.
   To ensure that the patient is comfortable. E

   Strenuous activity will result in falsely elevated readings (Bickley [18], E).

Procedure

1. 5.Show
   Place the first and second fingers, and optionally also the third finger, along the appropriate artery and apply light pressure until the pulse is felt (Action figure 14.10).
   The fingertips are sensitive to touch. Practitioners should be aware that the thumb and forefinger have pulses of their own and therefore these may be mistaken for the patient's pulse (Peate and Wild [157], E).
2. 6.Show
   For apical heart rate, place a stethoscope on the fourth or fifth intercostal space on the left mid‐clavicular line (typically under the breast area) and listen to the heart beat.
   The apical heart rate is usually recorded if the heart rate is irregular; this ensures a more accurate count (Bickley [18], E).
3. 7.Show
   Count the pulse for 60 seconds.
   Sufficient time is required to detect irregularities in rhythm or volume; however, if the pulse is regular and of good volume, subsequent readings may be taken for 30 seconds and then doubled to give beats per minute (Blows [21], E). If the rhythm or volume changes on subsequent readings, the pulse must be taken for 60 seconds (Bickley [18], E).
4. 8.Show
   Accurately document the result; additional factors, such as the rhythm, volume and skin condition (dry, sweaty or clammy), may be described in the patient's nursing notes.
   To monitor differences and detect trends; any irregularities should be brought to the attention of the appropriate senior nursing and medical teams (NMC [144], C). Additional qualitative characteristics of the pulse may aid diagnosis of the patient's condition (Brown and Cadogan [31], E).

Post‐procedure

1. 9.Show
   Discuss the result and any further action with the patient.
   To involve the patient in their care and provide assurance of a normal result or explain the actions to be undertaken in the event of an abnormal result (NMC [144], C).
2. 10.Show
   Wash and dry or decontaminate hands with an alcohol‐based handrub. Decontaminate any equipment used as per local policy.
   To prevent cross‐infection (NHS England and NHSI [124], C; NICE [127], C).