Assessing the Impact of Supplemental Oxygen Use on Deterioration Detection in the General Care Setting With Pulse Oximetry‐Based Continuous Monitoring

ABSTRACT

Aims

Continuous pulse oximetry monitoring has been used in patient deterioration recognition systems for decades. For patients on supplemental O2, questions related to the effectiveness of this approach have been raised due to elevation of SpO2 from O2 therapy. We examine this issue in the context of a stable inpatient continuous pulse oximetry-based rescue system with the aim of ascertaining if patients receiving supplemental oxygen are at risk of experiencing clinically meaningful delays in deterioration recognition as compared to patients on room air.

Design

Retrospective observational analysis.

Methods

Clinical markers of deterioration recognition timeliness and impact were compared for patients receiving various levels of supplemental oxygen and those on room air over 6 years. Chart review was conducted to assess cause and likelihood of preventability and improvement in detection with other monitoring modalities for emergent cases.

Results

Analysis adjusted for patient characteristics, and population level supplemental oxygen use showed no difference between patients on supplemental oxygen vs. room air for transfer rate, emergent transfer rate, or death after rescue or transfer. Analysis excluding population supplemental oxygen modeling showed limited increases in event likelihood, but not for emergent transfers. Chart review of emergent transfers revealed no pattern of delay in recognition of deterioration for patients on supplemental oxygen.

Conclusions

This study found no evidence that pulse oximetry-based continuous monitoring significantly degrades or delays detection of severe deterioration episodes for patients receiving supplemental oxygen. These findings challenge arguments suggesting pulse oximetry is not an appropriate continuous monitoring modality for general care patients receiving oxygen.

Implications for the Profession and/or Patient Care

This study provides clinical nurses with information about using continuous monitoring when caring for patients who are receiving supplemental oxygen in the general care setting. The study also assesses patient safety of the practice of using pulse oximetry for monitoring in this patient population.

Impact

This study addresses concerns related to using continuous pulse oximetry monitoring for deterioration detection when patients are receiving supplemental oxygen. This study found no evidence that pulse oximetry-based continuous monitoring significantly degrades or delays detection of severe deterioration episodes for patients receiving supplemental oxygen. The results can be used by the inpatient nursing community to ensure safe practices are in place for patient care.

Reporting Method

This study adheres to the STROBE reporting method.

No Patient or Public Contribution

Patient and/or public contribution was not deemed applicable for the rigorous design and execution of this study.