Title: Monitoring of Patients in An Acute Care Setting

Abstract

Background/Introduction: Patient Controlled Analgesia (PCA) is associated with a high risk of adverse events, specifically Opioid Induced Respiratory Depression (OIRD). It is common that Continuous Pulse Oximetry (CPOX) is applied to alert nurses of oxygen desaturation that can occur with adverse events. Continuous capnography is used to track the ventilation of patients and measures the end tidal CO2. Telemetry monitoring is important to predict and prevent patient complications. Denver Health’s policy concerning the frequency of telemetry in acute care cardiac patients was identified an important policy to review and update with current literature.

Purpose: Regis University Loretto Heights School of Nursing Honors nursing students worked in collaboration with Denver Health for this project. The purpose of this evidence-based practice (EBP) project was to review and appraise literature to assist Denver Health re-evaluate their current policy regarding best practices in the detection and prevention of OIRD with the use of continuous pulse oximetry or the use of continuous capnography. The policy needed an update as to acute care unit adults with tele monitors and to answer the clinical question: In acute care patients, are Q8 hour tele strip interpretations compared to Q12 hour tele strip interpretations more accurate in detecting cardiac complications during inpatient hospitalization?

Learner Outcomes/Objective: The learner will describe 3 best practices backed by the evidence for monitoring acute care and cardiac patients for complications.

Methods: A literature search was performed with the following databases: Cochrane Library, MEDLINE, PubMed, NCBI, Ebscohost and Google Scholar. The keywords used included: “Patient Controlled Analgesia,” “Continuous Capnography,” “Continuous Pulse Oximetry,” “CPOX,” “Respiratory Depression,” “OIRD,” “benefits of telemetry,” “tele strip,” “Q8 or Q12 telemetry monitoring,” “Cardiac telemetry,” “telemetry frequency.”Only articles within the last five years were used and the levels of evidence were at least a level four, with one article below that. Five articles were selected and appraised to make recommendations for each clinical question.

Results: The key findings from the studies resulted in recommendations for continuous capnography over CPOX for patients on a PCA pump. The ideal form of monitoring involves live updates and alerts to the nursing station in real time. While CPOX may be useful in the detection of adverse events it was found that detection was too late and led to late intervention. For telemetry interpretation results, literature showed Q8 hour telemetry strip interpretations rather than Q12 hour were considered best practice due to the increased quality of life, better clinical outcomes, and early detection of complications seen in research on patients with telemetry monitoring.

Conclusions/Implications for Practice: The current Denver Health Policy on PCA monitoring policy reflects best evidence and references were updated. Additional monitoring with CPOX, while studies state unnecessary, may also provide re-assurance to the safety of the patient. EBP for telemetry strip interpretation led to a recommendation for a change in policy concerning cardiac patients on telemetry monitoring to Q8 hour telemetry strip interpretations rather than Q12 hour.