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

Rationale and Comments

Nurses use continuous electrocardiography, respiratory, and pulse oximetry monitoring to track patient vital signs and trends and to help identify signs of patient status deterioration. However, significant cost burdens can affect the entire health care system when pulse oximetry and physiologic monitoring are used inappropriately. The high number of alarm alerts and level of noise created by these alarms lead 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 Association of Neuroscience Nurses, Society of Pediatric Nurses, & American Pediatric Surgical Nurses Association, Inc.

Sources

Expert consensus

Disciplines

Pediatric

References

Fuijkschot J, Vernhout B, Lemson J, et al. Validation of a paediatric early warning score: first results and implications of usage. Eur J Pediatr. 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. Hosp Pediatr. 2015;5(3):160-163.
Murray JS, Williams LA, Pignataro S, et al. An integrative review of pediatric early warning system scores. Pediatr Nurs. 2015;41(4):165-174.
Sendelbach S, Wahl S, Anthony A, et al. 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.