MedWire News: Implementing universal pulse oximetry monitoring in an orthopedic unit reduces the frequency of patients requiring rescue events for cardiac or respiratory arrest, research shows.
After surgery, patients are not usually monitored, but are checked at frequent intervals, such as every 2 hours.
But as John Abenstein and Bradly Narr (Mayo Clinic, Rochester, Minnesota, USA) noted in an accompanying editorial: “Many things can happen to the average postsurgical patient in a 2-hour window; for example, a patient who is receiving narcotics and who has a high body mass index and sleep apnea.”
Andreas Taenzer (Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA) and colleagues gathered data on patients in a 36-bed orthopedic unit for 11 months before and 10 months after implementation of pulse oximetry monitoring.
The system was set to alert nursing staff via pager if oxygen saturation fell below 80% or heart rate became less than 50 or more than 140 beats per minute. There was a 30-second delay to alarm trigger to eliminate transient and motion-generated events.
This delay, plus the fairly low oxygen saturation level, was designed to reduce the number of false alarms, which the team says “will lead staff to become desensitized” and ultimately to ignore many of the alarms.
These criteria resulted in an average of four alarms per patient per day, or two per 12-hour nursing shift. The number of rescue events per 1000 patient discharges from the orthopedic unit fell from 3.4 before to 1.2 after implementation of pulse oximetry, but did not change in two control units.
Transfers to intensive care fell significantly from 5.6 to 2.9 per 1000 patient discharges from the orthopedic unit, but did not change in the comparison units. Taenzer and team note that this saved their institution 135 intensive care days annually just from one 36-bed unit.
In the period before pulse oximetry monitoring, four patients died either on the orthopedic ward or after transfer to intensive care. Two died in the period after its implementation.
In their editorial, Abenstein and Narr said: “The implications of this study are broad. The introductions of pulse oximetry and other monitors into the postoperative environment has not, in the past, been successful.”
They concluded: “We believe Taenzer et al have shown us a glimpse of the future. Not only will such systems allow us to improve the quality of care of our patients, but will also be a key to lowering costs.”
