Educational intervention lowers pulse oximeter misuse in ICU

After an educational presentation on the proper use of pulse oximeters, off-label placement of the sensors decreased from 15.2% to 1.6%, according to a study published in Critical Care Nurse.

“When trying to get an oxygen reading, it can be easy to use the same sensor in various points, but pulse oximeters are not interchangeable,” Danielle Hlavin, BSN, RN, CCRN, CMC, charge nurse at UCHealth Memorial Hospital Central, said in a press release from the American Association of Critical Care Nurses. “By taking the time to understand the barriers to practice, we identified sustainable solutions and reinforced best practices for using the correct type of sensor and preventing pressure injuries that may develop.”

In a quality improvement project, Hlavin and Maureen Varty, PhD, RN, a research nurse scientist at UCHealth and an assistant professor at University of Colorado College of Nursing, conducted an audit with 508 observations from August 2020 to October 2020 at UCHealth to see how often off-label placement of finger probes was occurring in critical care units. They also assessed for changes in practice after various staff members, including critical care nurses, patient care technicians, advanced care partners and respiratory therapists, watched a 12-minute educational presentation outlining where to place the device for an accurate reading, device limitations and manufacturer guidelines.

In addition to the audits taken before and after intervention, researchers also conducted surveys before and after to measure the staff’s understanding of and confidence in the appropriate use of pulse oximeters.

Of the 508 preintervention observations, researchers saw that 77 patients (15.2%) had a finger pulse oximeter probe incorrectly placed on their earlobe. However, only six of 365 (1.6%) observations after the educational intervention showed an off-label use, including three (0.8%) finger probes placed inappropriately on the ear and three (0.8%) ear probes placed on the nose.

Overall, 185 staff members took part in the preintervention survey, and 140 took part in the post-intervention survey.

Despite 170 (91.9%) staff members agreeing or strongly agreeing with the statement, “I know factors that may affect oxygen saturation accuracy” before intervention, only 72 (38.9%) answered that they understand finger probes should not be placed on a patients’ ear.

After the educational presentation, 128 (91.4%) staff members said they knew about the factors that can impact oxygen saturation accuracy, and 119 (85%) said they understood that finger pulse oximeters are not to be placed on a patients’ ear.

Researchers also looked at availability of pulse oximeter supplies and the barriers associated with them in the hospital. They found that staff members had a hard time locating ear probes in an anecdotal example, and this greatly contributed to off-label placement.

Hlavin and colleagues wrote that the above results helped convince hospital leaders to buy 90 ear probes for UCHealth’s critical care staff to use appropriately.

“Educators and those involved in assessing health care staff members’ practices should evaluate whether pulse oximetry sensors are being used in an evidence-based way that aligns with manufacturer guidelines,” Hlavin and Varty wrote.

“Health care systems have had increased staff turnover as a result of the COVID-19 pandemic, and this has greatly impacted critical care areas,” they added. “This turnover can lead to increased hiring of travel or agency nurses, which means less continuity of education regarding best practices or hospital-specific policies. Staff turnover makes this education and intervention even more important because the new health care staff members who replace those who leave may not have the knowledge necessary to ensure safe pulse oximetry use.”

Reference:

• UCHealth initiative reduces off-label pulse oximeter placement. https://www.aacn.org/newsroom/uchealth-project-improves-pulse-oximetry-practices. Published Dec. 1, 2022. Accessed Dec. 13, 2022.