Pulse Ox

[marsbar37, BSN, RN]

Are you allowed to use pulse ox on students? In NY we cant which I find ridiculous since its such a valuable tool especially on our asthmatics.

 

[k1p1ssk, BSN, RN]

I've never been told not to... What is the rationale for not letting you do it? I can understand why you wouldn't be allowed to do continuous O2 sat monitoring - that can come with a risk for skin irritations and burns, but just taking an O2? That seems a little overzealous...

[marsbar37, BSN, RN]

well the very robotic answer I was given was that its DOE decision and we must follow their guidelines and protocol

WOW!

[k1p1ssk, BSN, RN]

Hmmm. Who is the robot??? I have spent about 30 minutes looking at the NYS Dept of ED website and NYS Nursing Practice guidelines and can't find anything specifically about O2 sats - for or against.

I have found language that says that school nurses are basically allowed to do anything allowed under the Nurse Practice Act and other language that states that supervised unlicensed personnel who are trained in appropriate technique can take and record (but not interpret) vital signs, but it doesn't specifically call out O2s... I would argue that an O2 sat is part of a full set of vital signs, which an RN can definitely take as part of an assessment. 

I think I would contact the NYS School Health Center for clarification and maybe try to educate the person telling you no. 

https://www.schoolhealthny.com/ny

[GetBackToClassRN]

Our district does not allow us to do pulse ox checks without a doctor's order and the parent has to provide the oximeter.  The rule is the same about blood pressure also.

The reason they gave us is because we do not have a baseline for individuals or orders for what to do if the readings are out of "normal" range.

[beachynurse, ASN, BSN]

The rationale behind not using the pulse oximeter is that if we do use it we might not do as thorough a pulmonary assessment and miss something. I never rely on the pulse oximeter for anything to do with a pulmonary assessment, my stethoscope and ears are the best tools for that kind of assessment. 

[dianah, ASN]

If the school approves routine use of a pulse oximeter, then it assumes responsibility for the care, upkeep, and preventive maintenance of this piece of equipment -- which, I venture to say, is not gonna happen.  The nurse will ultimately be responsible, and be required to show documentation that it was routinely cleaned and tested.  Etc.

[londonflo]

beachynurse said:

I never rely on the pulse oximeter for anything to do with a pulmonary assessment,

Besides looking at capillary refill, waiting for their lips to turn blue, rapid respiratory rate.. how are you determining a "guess" on their oxygen level?

dianah said:

If the school approves routine use of a pulse oximeter, then it assumes responsibility for the care, upkeep, and preventive maintenance of this piece of equipment - The nurse will ultimately be responsible, and be required to show documentation that it was routinely cleaned and tested. 

And this is a Bad thing???

[dianah, ASN]

londonflo said:

Besides looking at capillary refill, waiting for their lips to turn blue, rapid respiratory rate.. how are you determining a "guess" on their oxygen level?

And this is a Bad thing???

Didn't say it was a bad thing.  Just stated what would be required.

[beachynurse, ASN, BSN]

londonflo said:

Besides looking at capillary refill, waiting for their lips to turn blue, rapid respiratory rate.. how are you determining a "guess" on their oxygen level?

And this is a Bad thing???

When you are doing a pulmonary assessment, hopefully your student isn't getting that bad off. I auscultate breath sounds, watch breathing patterns, watch for use of accessory muscles, retractions, tripoding, nasal flaring. You don't need a pulse oximeter to know when you see these things with poor breath sounds to know the child is in respiratory distress. We can only use the equipment that our school divisions allow us to use. 

[marsbar37, BSN, RN]

of course you would perform assesment and observation but a pulse ox can tell you right away their saturation and for kids who complain their hearts are beating so fast it gives a pulse and reassures the patient

[beachynurse, ASN, BSN]

marsbar37 said:

of course you would perform assesment and observation but a pulse ox can tell you right away their saturation and for kids who complain their hearts are beating so fast it gives a pulse and reassures the patient

Of course it would, that is if your school division allows you to use one. My school division does not allow us to use pulse oximeters as we cannot be held responsible for the calibrating of the unit.