Intermittent Pulse Oximetry OK for Kids Receiving Room Air

Troy Brown, RN

March 10, 2015

Intermittent pulse oximetry was effective for children hospitalized with asthma or bronchiolitis who were stable on room air but did not decrease the time until the child was medically ready for discharge, according to a new report from a quality improvement effort.

Amanda C. Schondelmeyer, MD, from the Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio, and colleagues report their findings in an article published online March 9 in Pediatrics.

Despite recommendations to limit the use of continuous pulse oximetry (CPOx) monitoring in these patients, it continues to be widely used, the authors note.

"In its bronchiolitis guidelines, the American Academy of Pediatrics emphasized the uncertain role for CPOx in the inpatient setting, citing risk of prolonged hospital stay resulting from 'perceived need for supplemental oxygen,' " the authors write. "Studies in adults have also highlighted the contribution of CPOx to alarm counts on units, which the Joint Commission has emphasized as a patient safety issue."

The Choosing Wisely initiative has also recommended discontinuing CPOx in these children.

For the quality improvement effort, the researchers developed consensus-based criteria for discontinuing CPOx for children hospitalized with wheezing. The interventions included staff education, a checklist that was used during nurse handoff, and incorporation of CPOx discontinuation criteria into order sets.

The investigators chose more than 90% oxygen saturations on room air for 2 hours or weaned to albuterol treatments every 2 hours as goals for timely CPOx discontinuation.

The investigators implemented the interventions on one medical unit and used a second medical unit in the same hospital as a control group. Nurses on the intervention unit, but not the control unit, were educated on the interventions, as were physicians who cared for patients on both units.

The researchers tracked time until the patient was medically ready for discharge, intensive care unit transfers, hospital revisits, and medical emergency team calls on both units. The researchers used run charts and statistical process control charts to evaluate the effects of the interventions.

The median time per week that patients were on CPOx after they met goals decreased from 10.7 to 3.1 hours within 3 months of implementing the interventions on the intervention unit and decreased from 11.5 to 6.9 hours on the control unit.

The proportion of patients in whom CPOx was discontinued within the goal time rose from 25% to 46% within 3 months of the start of improvement activities on the intervention unit and remained stable during the following 3 months. The proportion of patients in whom CPOx was discontinued appropriately remained unchanged, at 23%, on the control unit.

The time until medically ready for discharge did not decrease on either unit, and the percentage of patients who required intensive care unit transfer, hospital revisit, or medical emergency team call remained similar on both units.

"The study findings are relevant for clinicians caring for patients with asthma and bronchiolitis in the non-[intensive care unit] inpatient setting who aim to reduce waste in patient care," the authors conclude. "This study adds to the body of evidence supporting a more judicious approach to CPOx, by demonstrating likely safety of early CPOx removal and questioning the impact of supplemental oxygen on [length of stay]."

The authors have disclosed no relevant financial relationships.

Pediatrics. Published online March 9, 2015. Abstract

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