<p><strong>INTRODUCTION: </strong>Pulse oximetry monitoring is prescribed to children receiving home oxygen for chronic medical conditions associated with hypoxemia. Although home pediatric pulse oximetry is supported by national organizations, there are a lack of guidelines outlining indications and prescribing parameters.</p>

<p><strong>METHODS: </strong>A mixed-methods analysis of pediatric home pulse oximetry orders prescribed through the institutional home health care provider at a large US children's hospital 6/2018-7/2019 were retrospectively reviewed to determine prescribed alarm parameter limits and recommended interventions. Semi-structured qualitative interviews with pediatric providers managing patients receiving home oxygen and pulse oximetry were conducted to identify opportunities to improve home pulse oximetry prescribing practices. Interviews were analyzed using a modified content analysis approach to identify recurring themes.</p>

<p><strong>RESULTS: </strong>368 children received home pulse oximetry orders. Orders were most frequently prescribed on non-cardiac medical floors (32%). Attending physicians were the most frequent ordering providers (52%). Frequency of use was prescribed in 96% of orders, however just 70% were provided with specific instructions for interventions when alarms occurred. Provider role and clinical setting were significantly associated with the presence of a care plan. Provider interviews identified opportunities for improvement with the device, management of alarm parameter limits, and access to home monitor data.</p>

<p><strong>DISCUSSION: </strong>This study demonstrated significant variability in home pulse oximetry prescribing practices. Provider interviews highlighted the importance of the provider-patient relationship and areas for improvement. There is an opportunity to create standardized guidelines that optimize the use of home monitoring devices for patients, families, and pulmonary providers. This article is protected by copyright. All rights reserved.</p>