Research In Practice Blog
Intro
Bronchiolitis is an infection of the airways that causes cold-like symptoms and breathing difficulty, and most commonly affects children under 2 years old. It can be severe enough to require oxygen therapy, suctioning, or IV fluids, but guidelines specify limiting the use of continuous pulse oximetry (cSpO2) monitoring only to patients receiving supplemental oxygen. Even so, many pediatric patients for whom cSpO2 is not recommended are receiving it unnecessarily.
Study design & findings
As part of a 36-hospital deimplementation trial for cSpO2 in children hospitalized with bronchiolitis, real-time inquiry was conducted to explore why 25% of 2,052 patients who were not needing any supplemental oxygen were receiving cSpO2. Responses from 371 clinicians—nurses (76%), resident trainees (15%), attending physicians (4%), and others—were analyzed.
When asked about cSpO2 monitoring, 70% of reasons given were non-clinical, with the most common being: they forgot or did not have time to remove monitoring (28%); “don’t know/monitor was already on” (20%); “per order or policy” (13%); “not aware of new guidelines” (10%); “family preference” (9%); and an attribution of the decision to another person (9%). For the 30% of clinical reasons, the most common were: “recently required oxygen/room air challenge/nap test” (44%); “physical exam concerns” (31%); and “patient history or history of present illness” (17%).
Research in Practice Implications
Understanding why guidelines aren’t being followed is critical to improving practice. These findings suggest that unit workflows could be revised to generate more timely, appropriate discontinuation of monitors, and improved team communication and awareness about monitoring status and the rationale for monitoring outside the clinical guidelines.
Actionable Insights:
- Clinical: Incorporate monitoring discussion into hand-offs and rounds; Assign additional members of the healthcare team the task of discontinuing monitoring orders when appropriate; Introduce order sets that increase awareness of guidelines and monitor status
- Research: Develop deimplementation strategies to address the sources of clinicians’ concerns about unmonitored children on medical-surgical units.
Information & Resources
Clinical Futures author(s):
Halley Ruppel PhD, RN, Christopher P. Bonafide MD, MSCE
Additional study author(s) from Children’s Hospital of Philadelphia:
Kimberly Albanowski MHS-MA
Citation:
Ruppel H, Bonafide CP, Beidas RS, Albanowski K, Parlar-Chun R, Rajbhandari P, Kern-Goldberger AS, Stoeck PA, Snow K, House SA, Lucey KE, Brady PW, Schondelmeyer AC; Pediatric Research in Inpatient Settings (PRIS) Network. Continuous pulse oximetry monitoring in children hospitalized with bronchiolitis: A qualitative analysis of clinicians' justifications. J Hosp Med. 2024 Aug 9. doi: 10.1002/jhm.13442. Epub ahead of print. PMID: 39120261.