Assessment and Description of Problem
One of the first things we do when we assess a new admission is observe and record our vital signs. Within our new workflow, checking the pulse ox is one of those vital signs. Everyone of our patients goes through at least two pulse oximeters during their stay. All of our post surgical patients receive a continuos pulse oximeter. The pulse oximeter is an important piece of medical equipment that we rely on for important information specifically the oxygen saturation in the blood. Pulse oximetry has been integrated in clinical practice for almost three decades because it enables cost-effective monitoring of respiratory status and early detection of hypoxaemia (Milutinovic,2016). When the oxygen levels go down, we verify it and make changes to our plan of care depending on those levels. Every licensed and non licensed caregiver in the hospital is taught how to properly put on the pulse oximeter and how to read it. It is one of our most important assessment tools in the hospital environment. We have not had a change in our pulse oximetry reading in several years and our committee feels like this is a good time to advance this piece of technology as we prepare for our Magnet visit this uear.. Our shared leadership teams have been looking for ways to advance our technology in the upcoming year.
In the pediatric setting, our little patients wiggle and are rarely still. Our pulse oximetry system is so sensitive that that any tiny movement can cause the machine not to read the measurements correctly. When it does not pick up the reading, alarms go off not only in the room but on our central station monitors as well, They continue to beep until someone assesses and fixes the cause of the alarm. Our monitors attach to any of the four extremities. Our current sensor is having to be replaced daily especially now that we are changing the location of the pulse ox every 4 hours with vital signs as part of our pressure ulcer prevention. Safety is another issue we look at with our equipment. The cords to our pulse oximeter sensors are approximately 20 inches. While our patients sleep, they frequently get tangled or twisted. Keeping our patients safe is our highest priority. Our current pulse oximeters frequently are taken off our patients, fall off the bed and many times reused. Hygenically, this is not the best practice. As an active member of our PUP committee (pressure ulcer prevention), our current pulse cords can be a hazard if not repositioned every few hours. While sleeping, the white cord is often not moved off the patient as well, making it another risk for skin breakdown.
We are waking patients up throughout the night, repositioning, replacing sensors and trouble shooting the connectors. This is a common complaint from our nurses. The loud beeping throughout the evening is one of our most frequent compaints on our post discharge surveys. Customer service scores have been tracked and one of our lowest scores are loud beeps from our machines and monitors during the night. Many times, we become numb to the alarms and after audits, we have noticed that nurses and other staff do not even look up when the assume the patientis in the rest room or perhaps it has fallen off. This is called alarm fatigue and is an increasing problem on all shifts hospitals are the country. When rapid response calls have been studied, the first sign of distress is a change in vital signs, specifically the pulse oximeter (Myatt,2017). This is frightening and unacceptable behavior as we could be delaying treatment to a patient.We all have to become more cognicent towards alarms, even when it is not your patient.
Proposal
I propose as a hospital, that we use a new product for our pulse oximetry along with an alarm managment committee for our hospital system. Alarm fatigue for nurses is not an instant fix, nor will new equipment eliminate it. A committee to help audit and collect results has benefitted other hospitals and could be a great asset to our facility (Pelter,et al 2017). After researching various companies and their options, our team has discovered Ozzio. Ozzio, is a wireless, pulse oximeter device that can read the oxygen level from any part of the body . As we primarily use fingers and toes, this piece of equipment can also be used on the abdomen, back and other locations. One of the benefits of this pulse oximeter, is that it can be observed from a variety of locations including the central monitoring station and also to each Volte phone. If a patient is transferred to another unit or OR, once transferred with their medical record number, the numbers will then be recorded at the new location.
Benefits of the Ozzio
Nurses would be able to see their pulse ox readings whereever they are in the hospital from their assigned phone. If they hear an alarm, they can look and see if it is a good reading, if a patients has had a true decrease in oxygenation or if it has been disconnected. The nurse can then quickly determine to reassess her patient physically or make a call based on what she sees. We do not necessarily have to place the sensor on fingers and toes. This will make for some happier children who like their fingers free. Our patients will be able to walk the hallways while still being monitored. We can transport patients without the extra weight of the portable monitor. By placing the sensor on other parts of the body, its less likely that they will fall off or get tangled during the night, meaning one less alarm reason to go off. It will help the patients and families have better rest during the night.Yes,new equipment has challenges, and as the Ozzio becomes more popular, the challenges will be outweighed by the benefits.
Research studies have been done showing the decrease of Rapid Response calls when staff is attentive to the accuracy of the monitoring system (Weller, 2017). Our nurses would be able to see their oxygen saturations from their phone anywhere on the floor that they are. Like our current pulse ox, the Ozzio would need to be repositioned on the body to reduce skin irritation but unlike our current one, the Ozzio has the tendency to remain sticky for over 84 hours, making replacing it not as frequent as we currently do which in turn will reduce cost. After looking at our current population and the growth of our hospital system, I believe this would be a wise move. I propose doing a 3 month trial before making a final decision. For our trial, I have suggested we use two units on one of our campuses. The floors would be our day surgery area and 4 South, our primary post surgical floor. Each floor would have superusers (chosen by the floors leadership). The superusers along with the leadership team would have a training class, going over the new equipment, how to use it properly and how to trouble shoot the issue. I would like the trial to go over three months. At the time, feedback would be collected and brought back to this group, our shared leadership Equipment and Technology committee, for the final decision. We would then roll it out to all three campuses at the time. If successful, communication with the manufacture would be key, as technology and equipment continues to advance and we want to stay up to date with any changes.
In the pediatric setting, our little patients wiggle and are rarely still. Our pulse oximetry system is so sensitive that that any tiny movement can cause the machine not to read the measurements correctly. When it does not pick up the reading, alarms go off not only in the room but on our central station monitors as well, They continue to beep until someone assesses and fixes the cause of the alarm. Our monitors attach to any of the four extremities. Our current sensor is having to be replaced daily especially now that we are changing the location of the pulse ox every 4 hours with vital signs as part of our pressure ulcer prevention. Safety is another issue we look at with our equipment. The cords to our pulse oximeter sensors are approximately 20 inches. While our patients sleep, they frequently get tangled or twisted. Keeping our patients safe is our highest priority. Our current pulse oximeters frequently are taken off our patients, fall off the bed and many times reused. Hygenically, this is not the best practice. As an active member of our PUP committee (pressure ulcer prevention), our current pulse cords can be a hazard if not repositioned every few hours. While sleeping, the white cord is often not moved off the patient as well, making it another risk for skin breakdown.
We are waking patients up throughout the night, repositioning, replacing sensors and trouble shooting the connectors. This is a common complaint from our nurses. The loud beeping throughout the evening is one of our most frequent compaints on our post discharge surveys. Customer service scores have been tracked and one of our lowest scores are loud beeps from our machines and monitors during the night. Many times, we become numb to the alarms and after audits, we have noticed that nurses and other staff do not even look up when the assume the patientis in the rest room or perhaps it has fallen off. This is called alarm fatigue and is an increasing problem on all shifts hospitals are the country. When rapid response calls have been studied, the first sign of distress is a change in vital signs, specifically the pulse oximeter (Myatt,2017). This is frightening and unacceptable behavior as we could be delaying treatment to a patient.We all have to become more cognicent towards alarms, even when it is not your patient.
Proposal
I propose as a hospital, that we use a new product for our pulse oximetry along with an alarm managment committee for our hospital system. Alarm fatigue for nurses is not an instant fix, nor will new equipment eliminate it. A committee to help audit and collect results has benefitted other hospitals and could be a great asset to our facility (Pelter,et al 2017). After researching various companies and their options, our team has discovered Ozzio. Ozzio, is a wireless, pulse oximeter device that can read the oxygen level from any part of the body . As we primarily use fingers and toes, this piece of equipment can also be used on the abdomen, back and other locations. One of the benefits of this pulse oximeter, is that it can be observed from a variety of locations including the central monitoring station and also to each Volte phone. If a patient is transferred to another unit or OR, once transferred with their medical record number, the numbers will then be recorded at the new location.
Benefits of the Ozzio
Nurses would be able to see their pulse ox readings whereever they are in the hospital from their assigned phone. If they hear an alarm, they can look and see if it is a good reading, if a patients has had a true decrease in oxygenation or if it has been disconnected. The nurse can then quickly determine to reassess her patient physically or make a call based on what she sees. We do not necessarily have to place the sensor on fingers and toes. This will make for some happier children who like their fingers free. Our patients will be able to walk the hallways while still being monitored. We can transport patients without the extra weight of the portable monitor. By placing the sensor on other parts of the body, its less likely that they will fall off or get tangled during the night, meaning one less alarm reason to go off. It will help the patients and families have better rest during the night.Yes,new equipment has challenges, and as the Ozzio becomes more popular, the challenges will be outweighed by the benefits.
Research studies have been done showing the decrease of Rapid Response calls when staff is attentive to the accuracy of the monitoring system (Weller, 2017). Our nurses would be able to see their oxygen saturations from their phone anywhere on the floor that they are. Like our current pulse ox, the Ozzio would need to be repositioned on the body to reduce skin irritation but unlike our current one, the Ozzio has the tendency to remain sticky for over 84 hours, making replacing it not as frequent as we currently do which in turn will reduce cost. After looking at our current population and the growth of our hospital system, I believe this would be a wise move. I propose doing a 3 month trial before making a final decision. For our trial, I have suggested we use two units on one of our campuses. The floors would be our day surgery area and 4 South, our primary post surgical floor. Each floor would have superusers (chosen by the floors leadership). The superusers along with the leadership team would have a training class, going over the new equipment, how to use it properly and how to trouble shoot the issue. I would like the trial to go over three months. At the time, feedback would be collected and brought back to this group, our shared leadership Equipment and Technology committee, for the final decision. We would then roll it out to all three campuses at the time. If successful, communication with the manufacture would be key, as technology and equipment continues to advance and we want to stay up to date with any changes.
Amy, What a great project. Pulse oximetry reading is such a challenge, especially with young ones. I would be curious to hear how things go if you get approval for this project!
ReplyDeleteGreat information Amy. I enjoyed reading your blog. A new system like Ozzio will be great. I agree it is frustrating for our patients and us nurses when we constantly have to go to patients room when the alarm goes off, most of the time, it because they moved during their sleep and the pulse ox shifted. IT will be great to see this proposal approved, Lots of facilities will benefit from it.
ReplyDeleteAmy, great project. The Ozzio sounds like a great piece of technology. We have issues with puls ox a lot when we can't get a reading on patient fingers because they have on nail polish or if they are cold so being able to place this piece of technology in other location is a great benefit. Another great benefit is that it coordinates with your Voalte phone. That is great way to track the status of patients and another benefit is the decrease in alarms. I would love to look into this technology for our facility as well.
ReplyDeleteHi Amy, I enjoyed your blog! You provided us with some great information. I remember early in my nursing career working in the newborn nursery and in pediatrics. One of the things I remember most is the frustration of the parents and nurses when attempting to obtain accurate pulse oximetry readings at night. The patients were ill and would be awake all night with the monitor alarming. Neither the parents nor the patients got any rest, and the nurses found it difficult to monitor their patients. The use of the Ozzio sounds promising, good luck!
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