Choosing Wisely:

Don’t apply continuous cardiac-respiratory or pulse oximetry monitoring to children and adolescents admitted to the hospital unless condition warrants continuous monitoring based on objectively scored cardiovascular, respiratory, and behavior parameters.

Rationale and Comments: Nurses use continuous electrocardiography (ECG), respiratory, and pulse oximetry monitoring to track patient vital signs and trends, and to help identify signs of patient status deterioration. However, when pulse oximetry and physiologic monitoring are used inappropriately, significant cost burdens can affect the entire healthcare system. In addition, the high number of alarm alerts and level of noise created by these alarms leads to alarm fatigue. When high levels of false alarms occur in the work environment, clinically significant alarms may be masked by being silenced or unrecognized when clinicians become desensitized. In addition to alarm fatigue, continuous bedside monitoring of pediatric patients can provide a false sense of security that the patient is “safer” and that the nurse will note status changes in a patient more easily when a bedside monitor is used. Continuous bedside monitoring should not be used in place of hourly safety checks. Focused nursing assessments using a standardized early warning tool should be used to monitor changes in a pediatric patient’s status to identify deteriorations.
Sponsoring Organizations:
  • American Academy of Nursing
  • Sources:
  • Expert consensus
  • Disciplines:
  • Pediatric
  • References: • Fuijkschot J, Vernhout B, Lemson J, Draaisma J, Validation of a paediatric early warning score: first results and implications of usage. European Journal of Pediatrics. 2015;174(1):15-21.
    • Gazarian PK. Nurses’ response to frequency and types of electrocardiography alarms in a non-critical care setting: a descriptive study. Int J Nurs Stud, 2014;51(2):190-197.
    • Karnik A, Bonafide CP. A framework for reducing alarm fatigue on pediatric inpatient units. Hospital Pediatrics. 2015;5(3):160-163.
    • Murray JS, Williams LA, Pignataro S, Volpe D. An integrative review of pediatric early warning system scores. Pediatric Nursing. 2015;41(4):165-174.
    • Sendelbach S, Wahl S, Anthony A, Shotts P. Stop the noise: a quality improvement project to decrease electrocardiographic nuisance alarms. Crit Care Nurse. 2015;35(4):15-22.
    • Watkins T, Whisman L, Booker P. Nursing assessment of continuous vital sign surveillance to improve patient safety on the medical/surgical unit. J Clin Nurs. 2016;25(1-2):278-281.

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