Pulse ox, or other monitor, question

[perfectbluebuildings, BSN, RN]

Okay... as you all know I am sure, it's RSV/pneumonia/asthma season. I just want to see if anyone else has this issue or knows good ways to handle it?

Of course most of these kids are on pulse oxes. Since it is a general peds unit, there is no central monitoring station, and since the halls are long, sometimes a pulse ox can alarm with no one hearing it, and parents are upset when we finally do hear it and go in and say "it's been going off forever!!" I can understand their frustration too.

Of course, if we know a kid is alone, we leave the door cracked open to hear the alarm better and just generally watch them a lot closer. But when parents are there, we tell them to call us if they hear alarms and no one comes to check on the kid w/in a minute or two. Usually someone will hear the alarm before they have to call out, and come help; but not always, and not always as quickly as would be ideal.

But what is a solution to this.. I know it is not the parents' responsibility to be monitoring their child in this manner while they are hospitalized. I wish we did hear every alarm every time, but that is just not possible. Parents just don't feel their child is getting good care if an alarm is going off and no one medical may hear it; and I can understand that. However, how do you feel about parents being able to handle the responsibility of calling out about an alarm if it is not answered in a timely fashion; do you think that is asking too much? (That sounded sarcastic but I mean it sincerely.)

I have rambled quite a bit. If you have any suggestions, or questions about what the heck I'm trying to say, please send them my way...

[caliotter3]

To be frank, until someone comes up with a better solution, I think enlisting the aid of the parents in bringing alarms to the attention of personnel is a good idea. By explaining the situation to the parents, you are making them aware that you are aware of the problem and are attempting to address it. You are also acknowledging the presence of the parents and giving them a chance to provide input, even if it seems negative. That is better than saying nothing at all and letting the parents figure out the situation for themselves. Most parents would be looking for someone to answer the alarms without any prompting and would not be so cooperative. At least by doing it this way, you are allowing for some level of understanding thought processes on their part.

[Annony RN]

I agree with the PP about discussing it up front. Of course our moms rarely stay. We're a drop-off service.

Is it possible to create a temporary work area closer to the concerning room? An overbed table and chair in and empty room across the hall (yeah right, empty room) or in the hall itself. Might PO administration but then again, maybe that's the slap they need to get centralized monitors. Better that than an angry mom who writes to the paper or a kid who decompensates.

can you use baby (nursery) monitors? If I had to put a monitored kid away from the nurses station I did that a few times. Also did that in homecare of course so I could turn down alarms and let the kids sleep.

[MikeyJ, RN]

On our floor we try to educate our parents what the pulse ox is and what it implies when it is beeping. For infants, it is ok if an infant de-sat's to 86 or 87 every once in a while.. infants do that. So I teach the parents to push the "silent" button and to notify us if it maintains at that saturation level or if continues to go lower. And we teach them that when it does beep, that there is usually nothing wrong, but rather something is going on with the oximeter.

[littleneoRN]

sistermike,

I'm curious if you've ever had it come back to bite you when parents silence monitors. We explicitly teach our parents not to silence monitors. Most parents are smart people and learn well from us, but even still, sometimes they are not good at assessing a true desat from the pulse ox not picking up. Plus, even if my baby is rescuing himself out of desaturations, it's good to know how often it's happening and how long it's taking them to resolve. It just seems like some of the parents most eager to jump in and silence alarms are some of the least capable of assessing the situation. Have you ever had parents silencing monitors and waiting excessive periods of time, or for kids with extremely low sats that are more emergent? I'm just curious how this works out on your unit?

[NotReady4PrimeTime, RN]

Some of our long term parents will silence monitors but they never do so without asking permission. Those who silence the monitors without asking permission are politely asked NOT TO. The way our unit is set up, sometimes the parent can reach the silence button more easily than the nurse. Of course I work in a PICU and the whole arrangement is different than on the wards. When I worked extended care we had all our (HP Viridia) monitors linked (no central monitoring) so that when one monitor alarmed the alarming parameter popped up on the rest of the monitors. You could look at it and see if it was something that needed attention or not (kid's kicking his foot and the oximeter's having a cow vs RR of 10 and sats in the 70's) and even silence it remotely. This was a software solution and it worked well.

[candicane]

Most of our peds rooms are connected to a monitor at the peds station and in our icu for increased monitoring. A few are not and we have to use a portable sat machine to monitor that is not easy to hear. I always tell parents that if it is going off and we do not come in to turn the call light on because we may not hear it.

[JadedCPN, BSN, RN]

Even though I'm on a general surgical floor, all of our patients connected to monitors are connected to a central monitor that we can view at both of our nurses stations on the unit. We also are very strict on not allowing parents or patients to silence the monitors, we make sure we educate them on all of the numbers and meanings.

[traumaRUs, MSN, APRN]

The liability is HUGE when you are having parents monitor their children's alarms!

[wooh, BSN, RN]

We're on a big kick to have less continuous monitoring. Studies showing doesn't help outcomes, we end up keeping kids longer because it caught a momentary 85% while dead asleep and someone thought they needed oxygen so they end up staying another day. Without central monitoring, what's the point of "continuous" anyway, because unless someone is actually monitoring the monitor (and parents don't count), it's not really "continuous monitoring." I'd be getting with your Risk Management team on this, because you're looking at liability if you've got kids that are supposedly being continously monitored but in reality, are only getting intermittent pulse ox checks when you actually go in the room and see the monitor.

[rnsusan]

This is one of my pet peeves. I work on a surgical floor with many patients on continuous pulse oximeters. There is no central monitoring station. I can't here the alarms all the way down the hall.

I heard of one patient where the family member turned off the alarm. The staff did not realize the patient was decompensating until they had to call a code. Another time the parents were sleeping and did not hear the alarm. Neither did the staff because the door was closed. The patient was decompensating badly when the nurse went in for a routine check. In this case everything turned out ok.

One night my husband was on a pulse ox with the door open and close to the nurses station. The nurses had to hear the alarms. No one ever came in. I sat up the entire night monitoring him because the staff did not bother to. He would self correct and bring his sats up to his baseline after 1-2 minutes.

I get so frustrated when nurses do not respond to alarms because they are waiting for the parents to call out. Parents should be allowed to be parents, not forced to be medically responsible for there kids.

[canoehead, BSN, RN]

Do NOT trust parents with the alarms, they make some bizarre decisions. Sure, get them to hit the call light if one goes off, and even show them how to shut off the call light, but never the child's alarms. When I worked pediatrics I'd have some sort of close call almost every RSV season because parents hit silence because their child was sleeping (not sleeping- sats dumping!), or because I trusted them to hit the buzzer when they finished playing with baby so I could hook him to the moniter again (they didn't want me to wake the child, so left him sleeping without a moniter). If I have parents that start hitting moniter buttons I consider that a hugely high risk situation, educate, document, and then make that kid a frequent obs.

Once they find the silence button on one machine, they will silence IV pumps, feeding pumps, most anything, and the nurse won't know. Bad, bad idea.