Pulse Oximeter in Home Health setting

[Yeya02, BSN]

Hello, I have a general question for policy on pulse oximeter in home health setting.

The plan of care shows vital signs parameters for a child based on age and weight, however the patient is a vent/track patient. The POC states that patient should be on continuous pulse oximeter, the settings for high and lows are very different than the parameters listed on the standard orders. The settings are listed under the respiratory section of the POC. It also includes instructions on when to use CPAP and oxygen concentrator. My questions is this, when is the nurse to report vital signs out of normal ranges to a physician? Does she follow the orders with pulse ox settings or follow general parameters listed under standard orders?

I understand that the parameters should be the same on both sections but in this case it is not.

[NurseBlaq]

Did the physician order different parameters than the standard order? If yes, follow the physician's orders. If no, contact the physician for clarification of the orders.

[Yeya02, BSN]

The 485/POC lists normal parameters under the standard orders section. However under the respiratory section it states that the patient is to continuously be monitored by pulse oximeter, it states the high and lows. There is alarm settings. The patient uses a CPAP and oxygen concentrator on the orders as well. Those parameters are different than what was listed under standard orders. This is no longer a patient of mine. I just need some guidance on whether the respiratory orders supersede any other parameters listed.

[NurseBlaq]

I would say yes to following the respiratory orders over standard orders because the patient is vent/track. However, if there is ever a question and/or uneasiness about an order, contact the provider for clarification.

[caliotter3]

Follow the respiratory orders rather than the general policy orders. Inform the physician according to the parameters s/he states in their order. Some doctors do not require notification until a reading is "way" off. Prepare a communication note to the clinical supervisor requesting that all POC entries regarding this matter be made consistent (according to the respiratory orders. If they want to follow the general policy orders instead, then a change should be made and at any rate it needs to be made uniform across the POC). When you do this it is best to read the entire POC word for word and request consistent entries, word for word, for all matters, not just respiratory orders. I do this whenever I first go onto a case. I also read each POC update and follow up accordingly. This should be done by the primary nurse on the case (or it can be done by the night nurse who has more time to intently look over the POC without being interrupted). HTH

[vampiregirl, BSN, RN]

Are the standard orders you referred to a batch entry that is the same for every 485? If so, can you request that verbiage be added to the batch that specifies that patient specific parameters specified by a provider should be used rather than "standard parameters"? Ideally the parameters will match but this clarifies the POC in cases where standard orders pop up on every POC.

Batch orders can be helpful in some cases but in others they cause all kinds of confusion! Especially if something else in the POC contradicts them!