Policy Name: Patient Monitoring via the Patient SafetyNet (PSN) Monitoring System

Transcription

1 Healthcare Facility: Catholic Health Mercy Hospital of Buffalo Policy Name: Patient Monitoring via the Patient SafetyNet (PSN) Monitoring System Catholic Health Mercy Hospital of Buffalo has granted permission to Masimo Corporation to provide the above named document to other health care facilities in both electronic and printed form, and to include the document on its public website. Masimo does not endorse and has not validated this document. This document is provided for informational and educational use only. This document is not intended to be, and should not be used as, a substitute for clinical judgment by the appropriate health care professionals at a health care facility.

2 CATHOLIC HEALTH SYSTEM MERCY HOSPITAL OF BUFFALO POLICY AND PROCEDURE TITLE: Patient Monitoring via the Patient SafetyNet (PSN) Monitoring System PREPARED BY: Jon Carlson, Director, Respiratory Care Svcs Carol Latona, Director, Medical-Surgical Nursing RESPONSIBLE DEPARTMENT: Patient Care Services and Respiratory Care PAGE: 1 of 5 APPROVED BY: David Durante, MD Chief, Pulmonary Medicine Medical Director, Respiratory Care Services Kathy Guarino, RN Chief Nursing Officer, V.P. Patient Care Services PURPOSE: This policy is to guide health care providers performing pulse oximetry via the Patient SafetyNet Monitoring System (PSN). For patients placed on PSN, pulse oximetry monitoring shall be used to monitor oxygen saturation (SpO2) for patients at risk for developing hypoxemia, and to guide therapies and activities of the patient. PSN surveillance monitoring serves to improve recognition and response to changes in a patient s condition that could lead to patient deterioration. Parameters measured are intended to trigger early notification/response of potential physiologic deterioration. Pulse oximetry is a non-invasive arterial oxygen saturation (SpO2) measurement. PSN provides continuous, real time SpO2 and pulse rate readings. There is a high correlation between pulse oximetry and direct blood oxygen saturation when the SpO2 is greater than 60%. SpO2 > 92% is the normal patient value of hospital patients without acute respiratory compromise, post surgical, or chronic respiratory/cardiac disease. SCOPE: Patient Care Services and Respiratory Care Services GENERAL STATEMENT OF POLICY: It is the policy of Mercy Hospital to express its policies in writing. These policies shall, where applicable, include a prescribed procedure to be followed for successful implementation. The Policy and Procedure statements of Mercy Hospital of Buffalo stand as a recorded to guide the actions of those who are responsible for the Hospital s operation. Patient SafetyNet: Remote patient monitoring and clinician notification system to preempt unanticipated patient events by using pulse oximetry for SpO2 and pulse rate (PR) monitoring with wireless notification of nurses via a pager. Parameters measured are intended to trigger early in a patient population for whom physiologic deterioration could not be predicted. POLICY: Surveillance Monitoring via the Patient SafetyNet System, will be limited to patient care areas with PSN installed. All patients admitted to a PSN monitored floor will be placed on SpO2 monitoring. All patients will be admitted to the PSN system with First and Last Name fields completed. The addition of Respiratory Acoustic Monitoring (RAM) is available to monitor the patient respiratory rate (RR) and will be used on the following patients: 1. Patients with a Body Mass Index (BMI) > Patients with known OSA (Obstructive Sleep Apnea) not on CPAP/BiPAP 3. Patients on PCA pumps 4. Patients with a positive score from the Sleep Pattern / Quality section on the nursing admission assessment form. 5. As per specified MD order

3 Default Alarm Parameters: Mercy Hospital default PSN parameters are as follows: SpO2 Low alarm limit 83% Pulse Rate (PR) Low PR alarm limit of 50; High PR alarm of 140 Respiratory Rate (RR) Low RR alarm 7; High RR alarm 30 breaths per minute Individual patient parameters may be adjusted based on patient need. Alarm Adjustment: The adjustment of the alarms or bracketing allows the adjustment of SPO 2 and heart rate parameters by 10% +/- baseline when the patient s baseline is abnormal but compensated ( i.e., repetitive oxygen desaturation, known and asymptomatic low pulse rate). A reduction of the SpO2 alarm setting requires an acoustic respiratory rate sensor be placed and functional. Accuracy Validation: The validation of the oximeter accuracy is to perform a manual check of the patient s pulse rate. The pulse oximeter sensed pulse rate and the patient s pulse rate must correlate. Pagers: Each patient will be assigned to a registered nurse who is in charge of their care. Patients on PSN will be assigned a nurse notification pager through the PSN Admission/Discharge Station (central monitor). All patients on the PSN system will also be assigned a PSN backup pager that is carried by the Charge Nurse. All nurses will carry their assigned pagers. If they need to leave the nursing unit, they will handoff their patient and pager to a nurse who will provide coverage. Nurse Notification/Escalation System: PSN utilizes a dedicated wireless paging system to communicate patient alarm conditions to the nurse. For SpO2 there is a 15 second delay built into the unit at the bedside allowing the patient time for correction of the alarm condition. After 15 seconds, the audible bedside alarm will sound at the central monitor located at the nursing station. If the alarm condition persists for an additional 15 seconds, the nurse will receive a page. In the event the nurse does not respond to the patient within 60 seconds, the nurse and the charge nurse will receive a page. If there is still no response within 3 minutes from original event, both pagers will receive a second alert. NOTE: All nurses must wear their designated pager at all times in the patient care area. If the primary nurse needs to leave the nursing unit, they will conduct a nurse to nurse handoff of care for their patient assignment and hand off the pager to a nurse who will provide coverage. Interference Alert: High ambient light sources: surgical lamps, bilirubin lights, fluorescent lights, infrared heating lamps, and direct sunlight can interfere with measurements Assessment/Data Collection: Monitor the following factors that influence oxygen transport: Respiratory rate, effort, depth and presence of oxygen therapy Skin color and temperature Pulse and Capillary refill Pertinent medical history (e.g., respiratory/cardiac disease hemoglobinopathies) Documentation: At a minimum, SpO 2 and heart rate levels will be documented at the same time as vital signs. To detect trends in a patient demonstrating early signs of deterioration of drift SpO 2 may be documented more frequently to follow the trends. If there is a change in parameter settings from the original default surveillance settings or from condition monitoring settings, the nurse, must document the rationale for doing so in the medical record and obtain a physician order for the change.

4 Care and Management: Utilize the following guidelines to facilitate consistent and reliable oximeter readings: Topic Site Selection /Application Site Assessment Poor Perfusion Motion Venous Pulsation Light Interference Solution Nail polish and/or artificial nails must be removed Optical components of the sensor must be aligned Site selection is intended for use on finger or toe Avoid application to edematous tissue or distal to arterial catheters, intravenous lines and blood pressure cuffs Exercise caution with poorly perfused patients; skin erosion and/or pressure necrosis can be caused when the sensor is not frequently moved. Assess site frequently with poorly perfused patients and move sensor if there are signs of tissue ischemia (this may be as frequent as every 1 hour) Warm extremity or choose an alternate site. The site must be checked every shift to ensure adequate adhesion, circulation, skin integrity and correct optical alignment. Move the sensor to a less active site. Replace with a fresh adhesive sensor. Position sensor site at heart level. Avoid use of additional tape. Circulation distal to the sensor site should be checked routinely Cover the sensor site with opaque material in the presence of bright light sources. Bright light sources include direct sunlight, surgical lamps, infrared warming lamps and phototherapy lights. Safety: Reconfirm alarm settings if unit has been turned off. Do not use in the presence of flammable anesthetics. Do not expose the unit to extreme moisture. Do not use during an MRI (Magnetic Resonance Imaging). When Safety Net System is utilized: All nurses must wear their designated pager at all times in the patient care area. If the nurse needs to leave the nursing unit, they will handoff their patient and pager to a colleague who will provide coverage. Emergency Management: Apply oxygen therapy per protocol Call Rapid response and monitor open airway Patient/Family Education: Instruct patient, family and/or significant other in purpose of monitoring device Reinforce the need to report early symptoms of respiratory fatigue, shortness of breath, or distress Reinforce necessity of maintaining placement of sensor for continuous monitoring Surveillance Monitoring may be discontinued: Per physician order During physical activity e.g. physical therapy or ambulation During diagnostic testing if the Pulse oxygen trend is > 92% Patient Refusal Note: Rationale for why a patient is not monitored via surveillance monitoring must be documented in the medical report. Discharge: All patients monitored on PSN will be discharged from the Patient SafetyNet upon final departure from the unit.

5 Infection Control: The pulse oximeter unit and cords must be cleaned between each patient. Do not allow liquids to enter the interior of the instrument To Clean: Turn the bedside oximeter off and wipe down the unit and patient cable with an alcohol based-cleaner e.g (Sani-cloth or Cavi Wipes), 70% alcohol solution, or 10% bleach Cleanse non-disposable sensor with alcohol-based cleaner or bleach between patient use. Disposable sensors are to be reused on the same patient only, do not use a disposable sensor on more than one patient. Maintenance of the system: Respiratory Care is available for assistance trouble shooting Biomedical Engineering is responsible for maintenance of the PSN oximeters Information Technology (Helpdesk ) is the liaison with Masimo Technical Support Emergency Response for System Outage: Power Outage: o The in-room PSN oximeters will operate for up to four hours on battery power. o The PSN servers and IT switches are on a UPS and backup power supply Network/Communication System Outage: The nurse is notified by a flashing indicator on the Masimo pager in the event the nurse notification (paging) is down. A notification alarm at the PSN Admission/Discharge Station (central monitor) alerts staff These alarms alert the nurse to rely on the audible bedside or central monitor alarm. ORIGINATION/EFFECTIVE DATE: April 16, 2012 Initial s REVIEWED: REVISED: REFERENCES: FEDERAL LAW: NYS LAW: JCAHO STANDARD: Taenzer, A. and Blike, G. Impact of Pulse Oximetry Surveillance on Rescue Events and Intensive Care Unit Transfers Anesthesiology 2010; 112:282 7 HealthGrades. The Sixth Annual HealthGrades Patient Safety in American Hospitals Study. April Golden Col. HealthGrades Inc. Peberdy, et al. Cardiopulmonary resuscitation of adults in the hospital: A report of cardiac arrests from the National Registry of Cardiopulmonary Resuscitation. Resuscitation 58 (2003), Gao H, et al. Systematic review and evaluation of physiologic track and trigger warning systems for identifying atrisk patients on the ward. Intensive Care Med, (2007) 33: Goldhilll DR, White SA, Sumner A. Physiologic values and procedures in the 24 h before ICU admission from the ward. Anaesthesia, 1999, 54: Weinger MB. Dangers of Postoperative Opioids. Anesthesia Patient Safety Foundation Newsletter. 2006: Vol 21 No.4. Practice Guidelines for the Perioperative Management of Patients with Obstructive Sleep Apnea. Anesthesiology, 2006: 104: