I am attempting to troubleshoot some issues we have been having at our hospital that have resulted in patient harm while monitoring patients on continuous pulse oximetry. I work in ICU stepdown and we have seen a dramatic increase in the number of patients being monitored for continuous pulse oximetry with COVID. Understanding that that loose connections, a sweaty finger or patient conditions like afib/PVD/DM impact circulation and ability to monitor pulse oximetry, what type of system do you use and how to rate it's reliability?
We have had more than one patient die while supposedly being monitored on continuous pulse oximetry without anyone even knowing and this seems completely unacceptable to me.
Specializes in New Critical care NP, Critical care, Med-surg, LTC.
So sorry for your frustrations, and for the tragic losses suffered potentially unnecessarily. You've already gotten some good feedback from others, I don't have much to add. But I can definitely sympathize with your situation. Our hard wired cords in the ICU seem slightly less finicky, but the small remote telemetry boxes with the portable set are notoriously unreliable. They are also monitored at a remote desk and the monitor coordinators can't even get off the phone due to the frequency of calls to notify RNs/PCTs about low O2 alarms.
In our ICU, we use the neonatal pulse ox set ups that look like a band-aid to wrap around the finger, toe or earlobe. We find those much better than the regular sticker type for adults. I hope you can find something that works for your hospital, good luck!
Honestly, I think the only thing you can do is to push for more reliable equipment. That won't solve all the false alarms, but hopefully it will cut down on them.
I can 100% relate to alarm fatigue. The number of COVID patients with dementia and/or AMS is through the roof, so I never know if the low O2 alarm is because the patient's O2 needs are increasing, the patient removed the oxygen, or the patient removed the sensor. There's only so much time I can spend donning/doffing PPE to troubleshoot tech problems without other nursing matters slipping through the cracks. I feel terrible about it, but I've had to do a lot of restraints lately to make sure the patients keep their O2 on and their sensors attached, and even then I've had a ton of false alarms. It's worse when I'm dealing with PUI/PUM patients because it's fresh gown and gloves for every patient; at least on the + unit, I can just change my outer gloves and get into the next room faster.
The other wrinkle here is that the O2 sensors attach to our telemetry boxes, and the monitor techs send alerts to our phones. It's a good system in theory, but in reality, I can't access my phone while I'm in a COVID isolation room. So if I'm in a room with another patient when a message comes through, it could be quite some time before I'm out of there and able to see the alert.
Thanks for all the replies, so many good points and a good all-around discussion. We are also having issues similar to that TurtlesRcool explains and there is nothing quite like trying to log into your rooms on Vocera with an N95 or PAPR or CAPR on. "Did you mean Mechanical Plant Boiler #3???" Just glad I passed my fit test and and don't have to deal with wearing a helmet anymore.
I think now more than ever, it's important to address problems in a logical manner and not give into frustration, alarm fatigue, burnout and the chaos of being a Nurse in a pandemic. I see so many of our nurses that are overwhelmed, fatigued and doing thinks like not logging into their rooms on Vocera or a phone system, so that they aren't able to receive notifications about their patient's wonky pleth wave or V lead that has lifted off a hairy man's chest again.
Unfortunately, in one of our sentinel events, the alarms were blaring, fatigue and burnout was present, no one could get a hold of the nurse and the patient with a "bad Pleth wave" or a sensor off was decompensating and died without anyone knowing. This is the very, very, unfortunate reality of a global pandemic and my heart hurts for that patient and their family members.
As Nurses we should always respect that
Airway is always first,
Alarms are there for a reason and not to be ignored, no matter how fatigued we are, we have a responsibility to at least lay eyes on our patients.
I will post our recommendations included in our practice alert and let you know how it goes with the equipment reps.
Thanks for all the replies, so many good points and a good all-around discussion. We are also having issues similar to that TurtlesRcool explains and there is nothing quite like trying to log into your rooms on Vocera with an N95 or PAPR or CAPR on. "Did you mean Mechanical Plant Boiler #3???" Just glad I passed my fit test and and don't have to deal with wearing a helmet anymore.
I think now more than ever, it's important to address problems in a logical manner and not give into frustration, alarm fatigue, burnout and the chaos of being a Nurse in a pandemic. I see so many of our nurses that are overwhelmed, fatigued and doing thinks like not logging into their rooms on Vocera or a phone system, so that they aren't able to receive notifications about their patient's wonky pleth wave or V lead that has lifted off a hairy man's chest again.
Unfortunately, in one of our sentinel events, the alarms were blaring, fatigue and burnout was present, no one could get a hold of the nurse and the patient with a "bad Pleth wave" or a sensor off was decompensating and died without anyone knowing. This is the very, very, unfortunate reality of a global pandemic and my heart hurts for that patient and their family members.
As Nurses we should always respect that
Airway is always first,
Alarms are there for a reason and not to be ignored, no matter how fatigued we are, we have a responsibility to at least lay eyes on our patients.
I will post our recommendations included in our practice alert and let you know how it goes with the equipment reps.
That is so unfortunate, I really hope your employer doesn't throw the nurse under the bus. We all know that alarm fatigue leads to complacency, and while I agree we must not allow our selves to become complacent, it is easier said than done during extraordinary times. Hopefully your employer will see this as evidence that they need to address the technology their using.
What kind of ratios are you running? Early in the pandemic, we were making all Covid patients 1:1. I believe that's still the case in our ICUs. It's a bear to staff, but there's just no substitute for eyes on a patient.
I am so lucky to work at a hospital that has leadership that is supportive and listens to their Nurses.
Not to be a total Debbie Downer but, you know, being supportive (with regard to this particular topic) means action, pronto. Like, if we can't fix our alarm system immediately then we are going to implement temporary plan B such as increased staffing...now. It should not have taken a death or one nurse's commitment to this issue to recognize widespread nurse fatigue or problems with monitoring patients' SpO2 or to recognize that the monitor techs are overwhelmed. These are problems that are routinely ignored or left for those on the ground to deal with in real time and then those same ones will eventually be vilified since no explanation or excuse is good enough when someone has had a bad outcome.
I hope your leadership is indeed supportive and I hope that they are actively demonstrating that--not waiting for you to meet with equipment reps and write up a big report. Though those actions are obviously also important.
1000 Alarms in a 4 hour period... if there's a monitoring room with a tech having to watch and listen to that I'd be afraid they'd wind of developing an off shoot of ICU induced psychosis ?
Do you you adhesive pulse oxs or the clip-on ones? I find more success with the adhesive type wrapped securely around a finger (or even a toe) to get a good waveform. Otherwise you could always try ear or forehead probes for patients who are difficult to get an accurate reading on due to poor circulation. Really, it sounds like more of a systems problem. Your facility sounds like it needs new equipment/capabilities to support a better monitoring system. Not an easy fix, but maybe you can use the unfortunate case of pt death to incite some change with upper management? Best of luck!
JBMmom, MSN, NP
4 Articles; 2,537 Posts
So sorry for your frustrations, and for the tragic losses suffered potentially unnecessarily. You've already gotten some good feedback from others, I don't have much to add. But I can definitely sympathize with your situation. Our hard wired cords in the ICU seem slightly less finicky, but the small remote telemetry boxes with the portable set are notoriously unreliable. They are also monitored at a remote desk and the monitor coordinators can't even get off the phone due to the frequency of calls to notify RNs/PCTs about low O2 alarms.
In our ICU, we use the neonatal pulse ox set ups that look like a band-aid to wrap around the finger, toe or earlobe. We find those much better than the regular sticker type for adults. I hope you can find something that works for your hospital, good luck!