Use of an Oxymetor

sharona97, BSN, RN · Mar 1, 2008

nursegirl
oxometers are not a requirement in hospice nursing for gauging symptom control. If your hospice "requires" you to take an o2 sat during visits, they should provide the oximeter, I have recently found the finger oximeters for as little as $65 on several websites, the last ones I ordered for my staff at this price are quite durable and work well. Discuss with your administrator the need to provide you with the proper equipment to care for your patients. What would you need an oximeter for if you left this type of nursing? Those types of equipment, if "required" should be provided to you for proper assessment. I, personally, wouldn't work for anybody that imposes these types of hardships for their staff.

We needed to use oxymeter in Internal Med at rest and w/6mn walk, looking for a drop to 89% or below to qualify our respiratory patents (off O2) on medicare to continue receiving O2 per Medicare standards, to answer your question where else would you us the oxymeter for billing I presume. We recerted our patients q3mo - q1yr depending on dx. I agree the equipment should be available and provided.

Em1995 · Mar 1, 2008

I have some strong feelings about the use of oximeters in hospice. As a long-time ER nurse, and now a full-time hospice nurse, I have often seen these measurements to be inaccurate and over-used(and, I saw those inaccuracies many times in the ER). Oxygen satuation measurements can be inaccurate for a variety of reasons: excessive movement,anemia (a biggie and one we see a LOT in hospice), hypoperfusion(blood loss or poor perfusion).

I often recommend to discontinue all labs, diagnostics, weights and oxygen saturation measurements in my patients...and, especially in facility patients.We treat the patient's subjective symptoms, so we ought to be looking at and listening to them instead of a number. I've found too many patients who were inappropriately intubated secondary to a nurse doing this reading and calling an ambulance!(Makes me cringe....we need to look at and listen to THE PATIENT!) What happens in facilities is that although we do educate the staff re: hospice philosophy and care, the turnover is high and many times agency nurses are working who are not familiar with the patient nor with hospice.So, if they do an oximeter reading and get 75%, the patient gets shipped out to the ER!

So many times, in so may clincial settings, I have seen nurses and docs get so wrapped up in the damn numbers, that they failed to see and hear the person/patient. Sorry....stepping off my soapbox....

rnboysmom · Mar 3, 2008

Our LCD's require both:

1. dyspnea at rest or poor response to bronchodilators and/or increasing ER visits, pulmonary infections and/or respiratory failure

and

2. Hypoxemia at rest on room air aeb pO2

or Cor Pulmonale, RHF, resting tach>100bpm as supportive criteria (with proper clinical documentation) for hospice admission.

Our nursing staff utilizes oximeters on admission and recertifications for the required clinical data to satisfy our intermediary(Palmetto can be quite the stickler when it comes to having the documentation they want in order to PAY you for all of your hard work in caring for your clients). We, by no means, utilize oximeter data as the sole assessment for patient condition. The key is good documentation of the patient's report of how they are breathing.

mommazac · Mar 5, 2008

It is a Medicare regulation to have a physician order for an O2 sat, at least in the CHHA, the agency I worked for underwent a Medicare survey and were cited for performing O2 sats on pts without an order. You must also have parameters requiring MD notification. It has nothing to do with billing.

coralynwoodson · Mar 7, 2008

I agree with each of you to a point about the use of the pulse oximeter. However, while in Hospice and Palliative Care Nursing we observe our patients as we do, I have learned that the oximeter give us a measureable guideline for what the oxygen saturation is in the patient's blood whether he or she is having dypsnea or not. For instance, last month I had a patient who was diagnosed with stomach cancer with mets. He also had a trach stoma. He stated that he felt fine and was having no trouble breathing. I noticed cyanosis to his lips and nailbeds. I retrieved an O2Sat of 78%. Within a few moments of telling me that he felt ok, he began to have mild dypsnea. I initiated 1L of O2/NC. Checking the SaO2 15minutes later, his oxygen saturation was up to 85%. He had less dypsnea. He did not realize that he was about to get into trouble. The measurable guideline I used was helpful in my determining his need for assistance. By the way, we have standing orders to maintain oxygen saturation at a level which is conducive to the patients limits and needs.:typing Coralyn W.

leslie :-D · Mar 8, 2008

I agree with each of you to a point about the use of the pulse oximeter. However, while in Hospice and Palliative Care Nursing we observe our patients as we do, I have learned that the oximeter give us a measureable guideline for what the oxygen saturation is in the patient's blood whether he or she is having dypsnea or not. For instance, last month I had a patient who was diagnosed with stomach cancer with mets. He also had a trach stoma. He stated that he felt fine and was having no trouble breathing. I noticed cyanosis to his lips and nailbeds. I retrieved an O2Sat of 78%. Within a few moments of telling me that he felt ok, he began to have mild dypsnea. I initiated 1L of O2/NC. Checking the SaO2 15minutes later, his oxygen saturation was up to 85%. He had less dypsnea. He did not realize that he was about to get into trouble. The measurable guideline I used was helpful in my determining his need for assistance. By the way, we have standing orders to maintain oxygen saturation at a level which is conducive to the patients limits and needs.:typing Coralyn W.

but even w/o the pox, you would have thrown on some o2.

you didn't need a pox to assess his dyspnea or cyanosis.

we have 1 in our entire facility- and the med'l dir just did not want to get it.

it's never used, btw. :)

leslie

RN BSN 2009 · Mar 8, 2008

The hospice I work for requires us to use them!! They order them for us, but we pay for them over time out of our checks! For us its a requirement on the assesment! Mainly more important with the patients that have respiratory issues!!!!

Wow, do they at least let you keep it when you leave?

hospicenurse · Mar 8, 2008

The hospice I work for has it's own DME and they say they must have an 02 sat below 90 before they can provide 02. There is nothing in the regs that says this, so I suspect it is either a leftover mindset from when this company had a homecare dept., or it is an attempt at cost cutting, or both.

hn

coralynwoodson · Mar 10, 2008

Yes, some patients are aware that they are "breathless", but then their are others who do not realize what the changes are they are experiencing. I have experienced seeing this since I have been in hospice. Some nurses may have experienced patients who have delirium or who may ask, what is happening to me. When this occurs, the nurse must make the decision to provide comfort to the patient at his or her dying time. My rationale is to have measureable documentation. We know now that we must document throughly everything we do in hospice, and that includes determining by measureable means the reason we did what we have done. In our system here, surveyors will tear a chart apart looking for this documentation. Experience has taught me to document, document, document. Hope this gives light to you on why I have rationaled using O2 on a person who knows he is breathless.