Do you as a Hospice Nurse use a pulse oximeter?

[SoCalRN1970]

I have found that more and more nurses are carrying and using their own portable Pulse Ox. I personally dont' like to use them we all know our patient's pulse ox's will be nothing near normal for the most part... family members often tend to focus on numbers I have found when following nurses who use these.

DO you feel they are appropriate? Most hospice agencies do not provide these items. I feel it's an expense that I don't wish to put out there,but like I said more and more of my colleagues are using these.

What are your ideas on this subject matter?

[nhelkhound]

I feel that the use of a pulse oximeter in Hospice may be a moot point, but Medicare conditions of participation wants to see

[netglow, ASN, RN]

Yes for admit contingent info (on 02 and off 02 sats), and as something else to let you the RN know what's going on. My co. provided all of us with pulseox.

[Irisheyessmilin]

My co. supplied them also. I also use P.ox. for some SOC assess but routine assess not routinely:D;). Pt families will focus on the number-makes things more difficult for everyone.

[tewdles, RN]

I am not an advocate of measuring pulse ox (in hospice), particularly in the end stage respiratory patient, for the same reasons mentioned above...the patients and the families tend to become fixated on the number rather than on the comfort of the patient.

[ErinS, BSN, RN]

I do routine spot checks of my patients sats, but it is never something I focus on. I rarely discuss detailed numbers and instead tell the family 'it is normal', or 'a little lower than last time'. I just like knowing for my charting and to ensure O2 settings are correct.

[tewdles, RN]

In my neck o the woods we titrate oxygen to comfort, not to pulse oximetry. My experience is that patients with long term resp problems (and their families) are rarely placated with "normal" or "a little lower than last time" comments...they are typically very drawn to the number and often own their own oximeters.

Please accept this as ongoing conversation and not as criticism or argumentative in intent...

[ErinS, BSN, RN]

I don't turn up O2 because of pulse ox, but I use high pulse ox as a reason to titrate pt's off O2. I am not a believer in O2 as a comfort measure- it seems like the hospital automatically puts O2 on patients. Even those who sat fine on RA. This is a pet peeve, since O2 increase fall risk, and leads to uncomfortable dry nose/nose bleeds, sores behind the ears, etc. I think because I start off discussing O2 sats in terms of 'good' instead of specific numbers, my patients get used to this. It is also not a focus of my assessment, I just slip it on quickly, and remove it after the reading, usually while checking my pt's BP. Anyways, I went without checking SpO2 for my first year and half, and now I do check it (for about the past 6 months). It doesn't make a huge difference, but a new manager wanted us to have more 'clinical data' in our charting, and began providing sat monitors.

[SoCalRN1970]

I will say that I don't plan on using a pulse ox. First of all, how can our agency endorse this item if they don't provide it? How can they callibrate it? How do they know your documentation reflects an accurate level?

Hospice patients are never normal with a pulse ox.. especially with o2 dependent copd, lung ca. etc...

I have found it challenging following nurses who whip out the little finger prob and families look at me like.. "Why don't you use one?" My answer? Because I find that all hospice patients especially towards the end of life have abnormal numbers. I find it easier to focus on symptoms and titrate o2 as needed. Its a hard sale though when nurses are buying pulse ox's on ebay and using them routinely on ALL patients.

I think it's an internal issue if we are audited by the state and they ask.. how do you callibrate your pulse oximetries your nurses inconsistently use?? Not good.

[newdawn_45]

I absolutely refuse to us a pulse ox in a Hospice setting and I encourage my nurses to do the same because once used everyone fixates on the number. I practice symptom management. I look at the whole picture and assess current and most probable future concerns. If I can't figure out if O2 will benefit my patient from that information I should consider a different profession.

[SoCalRN1970]

I feel that the use of a pulse oximeter in Hospice may be a moot point, but Medicare conditions of participation wants to see

That may be the case, but it's not the only requirement for end stage copd. Seriously? My mentor bought a pulse ox on ebay and suggest I do the same....

NO.

[stab88]

I may be way off topic. pls forgive. I care for my wife who's recently in hospice. at home..at 3am my choices seem limited. I just drained her plural sack,left w denver drain. I'm good at the task. BUT heres my diliema.

after draining 600mls, I saw a some traces of blood in the cath just at the point in enters the chest. (it was faint and pinkish marbled somewhat) I'm opting to wait another couple hours to call her hospice nurse,,, avoiding the ER nightmare. The local ER in my estimation is ill equiped to handle it.. I wont put her though the auto-pilot like intake that slows and frustrates the real matter at hand. She is well sedated 100mcg/h fentanyl patch w 10mg methadone,,,and quiet, comfortable and sleeping. 'massive bone masti.' Anyone watching threads? question must be ' how dangerous are we here?? cath is capped padded and tucked in well.. Sigh.