Patient Safety, Respiratory Compromise

Quality Healthcare is a Continuum: PPAHS Interview of Peggy Lange, RT on Intermittent vs. Continuous Monitoring

In a recent interview with Peggy Lange, RT (Director of the Respiratory Care Department, St. Cloud Hospital) conducted by the Physician-Patient Alliance for Health & Safety (PPAHS), Ms. Lange discussed why intermittent monitoring does not foster quality patient care.

St. Cloud Hospital is a 489-bed hospital serving a 12-county area in Central Minnesota. Said Ms. Lange, “St. Cloud Hospital has a long tradition of caring for patients in Central Minnesota. We were founded by the sisters of the order of St. Benedict in 1886 and have grown to a high quality regional medical center.”

Ms. Lange emphasized the shortcomings of intermittent monitoring:

“We know that when you walk out of the room, that’s when the alarm could happen, and that intermittent use is not as good as continuous, and then looking for the other signs of compromise.”

She discussed a case of a man who had undergone surgery and where intermittent monitoring would not have detected his onset of respiratory compromise:

“One of the patients that we reviewed with staff, had a surgical procedure on a shoulder. As the patient came out of the surgical area, out of the operating room, the vital signs were normal. So at 10:25 his pulse was 72, respiratory rate was 25, he was on a nasal cannula and his end tidal was 36. He had complained of pain, so at 10:30 50 of fentanyl was given.

“At 10:31, the respiratory rate dropped to 18. The nasal cannula was still on and this was still reading 40. By 10:36, the patient’s respiratory rate had dropped to 12, the oxygen saturation had dropped, they had turned the nasal up to 6 liters, and capnography was reading 17. Because this was one of the first cases we had, the staff thought that the machine wasn’t working. Because we set our alarms at 20 and 55, so certainly a 17 would give an alarm.

“At 10:38 the respiratory rate had started to come up, the nasal cannula was still on at 6 liters but reading only 90% sat, and our end tidal reading was still 16. By 10:40, when they talked with the gentleman about his surgery, he took a deep breath and his end tidal reading came to 34.

“Again, as you work with patients or you talk to patients they are going to take a deep breath and again a breath-to-breath measurement will have that reading go back to normal. And then when left alone you need to be careful that capnography numbers don’t go low again.”

In conclusion, Ms Lange discussed the benefits of monitoring with capnography:

“I do think that capnography is a tool that is very beneficial. I grew up in the time where pulse oximetry was a new tool and that was presented to us and it was presented as this wonderful, wonderful tool. And, now a new tool is coming and we’re kind of needing to put oximetry as a late sign.

“There are some naysayers in the world of understanding capnography, but I’ve seen it work for our facility. There are many articles out there being used in endoscopy suites, in PCA monitoring, and again, whenever a caregiver is concerned to be able to put it on.”

To listen to the interview with Ms. Lange on YouTube, please click here.

 

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