Decreasing Use of Continuous Pulse Oximetry in Pediatric Inpatients

Decreasing Use of Continuous Pulse Oximetry in Pediatric Inpatients

Lavanya G. Shankar, MD, Lurie Children’s at Northwestern Medicine Central DuPage Hospital.

Abstract Text:

Background: Pediatric inpatients with simple respiratory diagnoses and hypoxia do not have clear guidelines on when Continuous Pulse Oximetry (CPO) may be discontinued after initially being placed. As a result, patients who have been weaned off oxygen remain on CPO until discharge. This leads to unnecessary monitoring, costs and increased LOS.

Setting:Inpatient pediatric unit at a large community hospital affiliated with a tertiary care children’s hospital.

Methods: Pre-intervention data collection included a retrospective chart review of 42 pediatric inpatients requiring supplemental oxygen. Patients with bronchiolitis, chronic lung disease, home oxygen therapy, tracheostomy, heme/onc diagnoses were excluded.

Intervention: Implemented a “post-oxygen therapy” pulse oximetry monitoring guideline/order into the EMR. This read, “Discontinue CPO 8 hours after supplemental oxygen has been removed. Start spot pulse oximetry checks with vitals every 4 hours. CPO may be re-initiated if any signs of respiratory distress, not resolved by repositioning, suctioning or respiratory treatments.”

Results: Pre and post intervention data collection showed a majority of patients to carry the following diagnoses – asthma, reactive airway disease, pneumonia and upper respiratory infection. Average cost of hospitalization in the pre-intervention group was $19,262, post intervention group was $13,877 which is approximately 27% lower. Average Length of Stay (LOS) decreased from 62 hours to 44 hours per admission, a decrease of 29%. Both pre and post intervention groups had one 7 day readmission.

Limitations: Patients were not standardized for clinical severity which may have affected our results. There are no good severity scales that can unify all the common pediatric respiratory diagnoses mentioned above. In addition, after the intervention in our EMR system was made there was a significant lag in nursing staff adopting to the new order. Nursing staff followed the above order on average about 50% of the time. This improved significantly over time.

Conclusions: A simple order to discontinue Continuous Pulse Oximetry (CPO) after supplemental oxygen has been weaned off of pediatric inpatients with respiratory diagnoses, helps decrease length of stay (LOS) and minimize costs.