University of Michigan Health Systems, Ann Arbor, United States.
Int J Nurs Stud. 2013 Oct;50(10):1351-8. doi: 10.1016/j.ijnurstu.2013.02.006. Epub 2013 Mar 7.
Continuous pulse oximetry monitoring is recommended to improve safety during postoperative opioid use, however concerns with monitoring on general care units remain, given potential system barriers to alarm transmission, recognition, and nursing response.
This prospective, observational study evaluated unit and hospital-level factors affecting nurses' response to monitor desaturation alarms in postoperative patients on a general postoperative unit. With exemption and waiver of consent granted from the Institutional Review Board, monitoring data were downloaded from bedside monitors of postoperative patients. Alarm notification data and response times were recorded from the continuous capture of institutional surveillance data. Paging notifications were coded as clinically relevant (i.e., true oxygen desaturation with SpO2<89 for >15s) or irrelevant (i.e., artifact, inappropriate alarm threshold, or failure to delay page). Linear mixed models, and correlation coefficients were used to examine the relationships between unit staffing, shift, paging burden and response time. Means and [95% confidence intervals] are presented.
1616 monitoring hours in 103 patients yielded 342 desaturation events (duration 23.6s [20.99, 26.1]) and 710 notification pages, 36% of which were for clinically relevant desaturation. Nursing response time was 52.1s [46.4, 57.7], which was longer at night (63.8 [51.2, 76.35]; p=0.035), but not related to unit staffing. Missed alarm events (i.e., no notification page transmitted) occurred for 26% of the clinically relevant events, and were associated with higher paging burden (p=0.04), lower SpO2 values (81.8 [80.5, 83.0] vs. 83.2 [82.6, 83.8]; p=0.026), and higher odds of intervention (OR 3.5 [1.38, 8.9]). 65% of patients with desaturation events received interventions which correlated with the number of pages (rho=0.422; p<0.01) and events (rho=0.57; p<0.01), desaturation duration (rho=0.505; p<0.01), and SpO2 (rho=-0.324; p<0.01).
One-third of pulse oximetry alarm notifications were for clinically relevant oxygen desaturation, facilitating timely nursing response and intervention for most patients. Unit staffing and false alarm frequency were not associated with response time, suggesting a high level of attention on this unit. The nature and degree of missed alarm events suggests patient safety concerns posed by hospital-level transmission systems warranting further strategies to ensure monitoring safety.
连续脉搏血氧监测被推荐用于提高术后使用阿片类药物的安全性，但由于潜在的系统障碍，如报警传输、识别和护理响应，仍存在对普通护理病房监测的担忧。
本前瞻性观察研究评估了影响护士对普通术后病房术后患者监测设备发生低氧血症报警反应的单位和医院水平因素。在机构审查委员会豁免和弃权同意的情况下，从术后患者床边监测器下载监测数据。从机构监测数据的连续捕获中记录报警通知数据和响应时间。传呼通知被编码为临床相关（即 SpO2<89 持续时间>15s 的真正氧饱和度降低）或不相关（即伪影、不适当的报警阈值或未能延迟传呼）。使用线性混合模型和相关系数来检查单位人员配备、班次、传呼负担和响应时间之间的关系。给出了平均值和[95%置信区间]。
103 例患者 1616 小时监测时间共发生 342 次低氧血症事件（持续时间 23.6s[20.99,26.1]）和 710 次通知页面，其中 36%为临床相关低氧血症。护理响应时间为 52.1s[46.4,57.7]，夜间较长（63.8[51.2,76.35]；p=0.035），但与单位人员配备无关。错过报警事件（即未发送通知页面）发生在 26%的临床相关事件中，与较高的传呼负担有关（p=0.04），较低的 SpO2 值（81.8[80.5,83.0] vs. 83.2[82.6,83.8]；p=0.026）和较高的干预几率（OR 3.5[1.38,8.9]）。65%的低氧血症事件患者接受了干预措施，这与传呼页面数量（rho=0.422；p<0.01）和事件（rho=0.57；p<0.01）、低氧血症持续时间（rho=0.505；p<0.01）和 SpO2（rho=-0.324；p<0.01）相关。
三分之一的脉搏血氧饱和度报警通知与临床相关的氧饱和度降低有关，这有助于大多数患者及时进行护理响应和干预。单位人员配备和假报警频率与响应时间无关，表明该单位高度重视这一问题。错过报警事件的性质和程度表明，医院级传输系统造成的患者安全问题需要进一步采取策略来确保监测安全。
