HH Vital Signs to Include Pulse Ox?

[indbletrble]

I am finding a number of our therapy groups whom we contract with for supplemental support are evaluating the patient's O2 sats as a part of their routine vitals. This has not been a policy of our agency to do so I am constantly telling them they need an MD order to cover this. Now, our agency is taking a look at this process and are considering making it a policy for all our patients......regardless of the disicpline following the patient. What do others think about clincians using a pulse oximeter to obtain O2 sats as a routine part of assessing vital signs?

[caliotter3]

I believe in it, but was recently told to stop with my patient because no one had put it on the 485.

[annaedRN, RN]

I put it on the 485 for all patients - as PRN for respiratory assessment. That way it is covered as part of assessment no matter what the circumstance, checked or not.

[jmn126]

I put it on the 485 for all patients - as PRN for respiratory assessment. That way it is covered as part of assessment no matter what the circumstance, checked or not.

that's the way i tend to do it also.

[paddler]

As long as the agency provides the pulse oximeter! If not, it's sucky to require someone to take a SPO2 when they have to purchase their own equipment.

[linda1208rn]

more importantly, what do you do with the info if it is abnormal? or better yet, what are the normals?

then there is the question of supplying the pulse ox, who calibrates it? who passed your skill level/technique in use and esp evaluation?

even placing it on the 485, the above questions need an answer, so unless it is specifically ordered by resp, as an ongoing assessment for a disease state, i think it may be opening doors unnecessarily imo.

[systoly]

I believe Oximeters are a valuable and inexpensive adjunct when used correctly.

However, I've seen many a therapist freak out because they expected "normal" readings from a child with tetralogy of fallot or other congenital defect.

[indbletrble]

Thanks all for your input. We have raised the same questions Linda1208rn did on mulitple occasions, hence why we have not gone this route as yet. I read notes and see where the patient's sats have dropped following a therapy session, but no documentation regarding what the therapist did. In my mind this is a worse scenario than having not done one at all.

I am not going to be rushing in and revising the policy but will bide my time regarding this.

[KateRN1]

SpO2 readings are so tricky in home care and it's really a ridiculous situation. If you include it as required with all vital signs and it's not done, you have a deficiency for not following the POC. But, if you have it as a PRN for dyspnea and don't document that pt was short of breath, then again you're not following the POC. Coupled with all the other issues that Linda1208rn identified, it becomes far more difficult than it should be.

[nrsdolphin]

All of our nurses have pulse ox machines in nurse bag. We generally check on soc for a baseline, and then we check every home visit if they have dx of chf or copd, also if any major cardiac issues. These are addressed on 485. So far md's have had no problem. We generally report any sats below 90% to md, unless md gives specific guidelunes.

[KateRN1]

The issue isn't with physicians, the issue is with auditors and accrediting bodies and whether you're following the POC and your own internal policies.