The Alarm Burden of Excess Continuous Pulse Oximetry Monitoring Among Patients With Bronchiolitis

2021 ◽  
Author(s):  
Irit R Rasooly ◽  
Spandana Makeneni ◽  
Amina N Khan ◽  
Brooke Luo ◽  
Naveen Muthu ◽  
...  
Keyword(s):  
Pulse Oximetry ◽  
Supplemental Oxygen ◽  
Interquartile Range ◽  
Oxygen Excess ◽  
Intermittent Measurement ◽  
Continuous Pulse

Guidelines discourage continuous pulse oximetry monitoring of hospitalized infants with bronchiolitis who are not receiving supplemental oxygen. Excess monitoring is theorized to contribute to increased alarm burden, but this burden has not been quantified. We evaluated admissions of 201 children (aged 0-24 months) with bronchiolitis. We categorized time ≥60 minutes following discontinuation of supplemental oxygen as “continuously monitored (guideline-discordant),” “intermittently measured (guideline-concordant),” or “unable to classify.” Across 4402 classifiable hours, 77% (11,101) of alarms occurred during periods of guideline-discordant monitoring. Patients experienced a median of 35 alarms (interquartile range [IQR], 10-81) during guideline-discordant, continuously monitored time, representing a rate of 6.7 alarms per hour (IQR, 2.1-12.3). In comparison, the median hourly alarm rate during periods of guideline-concordant intermittent measurement was 0.5 alarms per hour (IQR, 0.1-0.8). Reducing guideline-discordant monitoring in bronchiolitis patients would reduce nurse alarm burden.

scholarly journals Prevalence of Continuous Pulse Oximetry Monitoring in Hospitalized Children With Bronchiolitis Not Requiring Supplemental Oxygen

JAMA ◽  
2020 ◽  
Vol 323 (15) ◽  
pp. 1467 ◽  
Author(s):  
Christopher P. Bonafide ◽  
Rui Xiao ◽  
Patrick W. Brady ◽  
Christopher P. Landrigan ◽  
Canita Brent ◽  
...  
Keyword(s):  
Pulse Oximetry ◽  
Supplemental Oxygen ◽  
Hospitalized Children ◽  
Continuous Pulse

CONTINUOUS PULSE OXIMETRY IN THE POST-ANESTHESIA CARE UNIT

1990 ◽  
Vol 70 (Supplement) ◽  
pp. S77 ◽  
Author(s):  
M D Daley ◽  
M E Colaenares ◽  
A N Sandler ◽  
P H Norman
Keyword(s):  
Pulse Oximetry ◽  
Anesthesia Care ◽  
Post Anesthesia Care Unit ◽  
Continuous Pulse

scholarly journals Continuous Pulse Oximetry Does Not Measure Blood Pressure

2018 ◽  
Vol 126 (3) ◽  
pp. 1089-1090 ◽  
Author(s):  
Frank J. Overdyk ◽  
Suzanne J. L. Broens
Keyword(s):  
Blood Pressure ◽  
Pulse Oximetry ◽  
Measure Blood Pressure ◽  
Continuous Pulse

scholarly journals Parental preference and perspectives on continuous pulse oximetry in infants and children with bronchiolitis

2018 ◽  
Vol Volume 12 ◽  
pp. 483-487 ◽  
Author(s):  
Mohamed Hendaus ◽  
Suzan Nassar ◽  
Bassil Leghrouz ◽  
Ahmed Alhammadi ◽  
Mohammed Alamri
Keyword(s):  
Pulse Oximetry ◽  
Infants And Children ◽  
Parental Preference ◽  
Continuous Pulse ◽  
In Infants And Children

scholarly journals Continuous Pulse Oximetry Monitoring in Bronchiolitis Patients Not Receiving Oxygen—Reply

JAMA ◽  
2020 ◽  
Vol 324 (13) ◽  
pp. 1350
Author(s):  
Amanda P. Bettencourt ◽  
Amanda C. Schondelmeyer ◽  
Christopher P. Bonafide
Keyword(s):  
Pulse Oximetry ◽  
Continuous Pulse

Supplemental Oxygen Compromises the Use of Pulse Oximetry for Detection of Apnea and Hypoventilation During Sedation in Simulated Pediatric Patients

PEDIATRICS ◽  
2008 ◽  
Vol 122 (2) ◽  
pp. 293-298 ◽  
Author(s):  
I. Keidan ◽  
D. Gravenstein ◽  
H. Berkenstadt ◽  
A. Ziv ◽  
I. Shavit ◽  
...  
Keyword(s):  
Pulse Oximetry ◽  
Pediatric Patients ◽  
Supplemental Oxygen

scholarly journals Pulse oximetry and supplemental oxygen use in nationwide Veterans Health Administration hospitals, 2013–2017: a Veterans Affairs Patient Database validation study

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e051978
Author(s):  
Xiao Qing Wang ◽  
Theodore Iwashyna ◽  
Hallie Prescott ◽  
Valeria Valbuena ◽  
Sarah Seelye
Keyword(s):  
Pulse Oximetry ◽  
Oxygen Therapy ◽  
Supplemental Oxygen ◽  
Face Validity ◽  
Veterans Health ◽  
Health Administration ◽  
Electronic Health Record Data ◽  
Patient Database ◽  
Electronic Health ◽  
Veteran's Affairs

ObjectiveExtraction and standardisation of pulse oximetry and supplemental oxygen data from electronic health records has the potential to improve risk-adjustment, quality assessment and prognostication. We develop an approach to standardisation and report on its use for benchmarking purposes.Materials and methodsUsing electronic health record data from the nationwide Veteran’s Affairs healthcare system (2013–2017), we extracted, standardised and validated pulse oximetry and supplemental oxygen data for 2 765 446 hospitalisations in the Veteran’s Affairs Patient Database (VAPD) cohort study. We assessed face, concurrent and predictive validities using the following approaches, respectively: (1) evaluating the stability of patients’ pulse oximetry values during a 24-hour period, (2) testing for greater amounts of supplemental oxygen use in patients likely to need oxygen therapy and (3) examining the association between supplemental oxygen and subsequent mortality.ResultsWe found that 2 700 922 (98%) hospitalisations had at least one pulse oximetry reading, and 864 605 (31%) hospitalisations received oxygen therapy. Patients monitored by pulse oximetry had a reading on average every 6 hours (median 4; IQR 3–7). Patients on supplemental oxygen were older, white and male compared with patients not receiving oxygen therapy (p<0.001) and were more likely to have diagnoses of heart failure and chronic pulmonary diseases (p<0.001). The amount of supplemental oxygen for patients with at least three consecutive values recorded during a 24-hour period fluctuated by median 2 L/min (IQR: 2–3), and 81% of such triplets showed the same level of oxygen receipt.ConclusionOur approach to standardising pulse oximetry and supplemental oxygen data shows face, concurrent and predictive validities as the following: supplemental oxygen clusters in the range consistent with hospital wall-dispensed oxygen supplies (face validity); there are greater amounts of supplemental oxygen for certain clinical conditions (concurrent validity) and there is an association of supplemental oxygen with in-hospital and postdischarge mortality (predictive validity).

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