Medical staff's knowledge of pulse oximetry: a prospective survey conducted in a tertiary children's hospital

Oximetry knowledge in neonatal units in Victoria, Australia: can we do better?

AIM

Pulse oximetry has become a widely used technology in medicine and is a standard part of monitoring in neonatal medicine. Knowledge of basic principles, clinical and technical considerations is important to optimise clinical benefit of use, but have been shown to be insufficient in paediatric staff. We aimed to assess knowledge of pulse oximetry in neonatal medical staff, a population not previously studied.

METHODS

A 21-item questionnaire (seven demographic, 14 knowledge) was devised and then administered to neonatal medical staff at all postgraduate levels working in the major public neonatal services in the state of Victoria, Australia.

RESULTS

Average test score was 64.4% (range 30.8-92.3%) with no correlation between years of experience and score. All respondents reported experience with oximetry, but only 57% reported adequate training in practical oximetry skills and only 28% in interpretation of downloaded oximetry data. About 45% reported knowing what an averaging time was but only 29% were able to provide an acceptable definition and only 10% knew what averaging time was used on devices in their units.

CONCLUSION

Significant knowledge deficits regarding oximetry are evident in neonatal staff, supporting the need for targeted and continuous training in oximetry.

Pulse Oximetry: A Survey of Knowledge among Staff of an Emergency Department

Introduction

Pulse oximetry measures arterial oxygen saturation and was introduced into the clinical field since the 1980s. It provides a simple, portable, non-invasive and inexpensive way for monitoring blood oxygen saturation. Previous studies demonstrated that most hospital staff had limited knowledge on the correct use of pulse oximetry and what might affect the readings. This study aimed at evaluating the extent of knowledge in pulse oximetry among the clinical staff of an emergency department.

Method

A 25-item multiple-choice type questionnaire was given to the medical and nursing staff of the Accident and Emergency Department (AED) of the Alice Ho Miu Ling Nethersole Hospital. In addition to demographic information, respondents were required to answer questions relating to the basic principles of pulse oximetry, recognition of physiological factors limiting its accuracy and management regarding hypothetical scenarios. The scores were expressed and analysed on a scale of 0–100.

Results

A total of 44 questionnaires were completed by 27 nurses and 17 doctors with their test scores ranging from 20 to 72 (median=46). Doctors (median=56) did better than nurses (median=44) in general (P=0.036) but this advantage, however, did not apply to questions on hypothetical scenarios where nurses performed better on the contrary. Correlation analysis proved that there was no linear relationship between respondents' test scores and their years of clinical experience (r=0.051, Spearman). This absence of linear relationship also applied to individual doctors (r=0.244, Spearman) and nurses groups (r=0.162, Spearman).

Conclusion

There was insufficient knowledge on the use of pulse oximetry among staff of the AED. The level of understanding did not correlate with their clinical experience. Training programs targeting both the fresh and the experienced staff are recommended.

Clinical nurses' knowledge level on pulse oximetry: A descriptive multi-centre study

OBJECTIVES

The aim of this study was to assess the level of knowledge on pulse oximetry among nurses. Understanding this is important because insufficient knowledge can lead to misinterpretation of pulse oximetry readings and consequently compromise patient safety.

RESEARCH METHODOLOGY

The study was cross-sectional and included a sample of 198 nurses. A modified questionnaire by Kiekkas et al. was used as the research tool.

SETTING

Intensive care units, anaesthesiology and emergency departments in two tertiary health care institutions in Serbia.

MAIN OUTCOME MEASURES

Principles of pulse oximeter function and conditions that can affect accuracy and reliability of pulse oximetry readings.

RESULTS

The lower percentage of correct responses about principles of pulse oximetry function was found in items related with the alarm reliability and understanding technical limitations. The factors that might affect pulse oximetry readings which were not identified by the nurses at a satisfactory level were the body position and specific kinds of ambient light. The mean scores of knowledge level were significantly different regarding departments (p=0.015).

CONCLUSION

Since this study revealed a lower level of knowledge in some aspects of pulse oximetry, it can be concluded that the generally firm belief that "experience is everything" can be challenged. This fact is important for the quality of health care and the patient's safety.

Graduate nurses' knowledge of the functions and limitations of pulse oximetry

AIMS AND OBJECTIVES

To examine nursing graduates' knowledge of functions and limitations of pulse oximetry.

BACKGROUND

Pulse oximetry is a technology ubiquitous in its use in modern clinical settings. Although the technology's ability to accurately reflect hypoxaemia in patients has been established, its contribution to improving patient outcomes is less certain. In addition, experienced nurses have previously demonstrated poor understanding of the limitations of the technology. Pregraduate education has been identified as a potential source of knowledge deficit and has been recommended by authors as an important target of investigation.

DESIGN

Cross-sectional, comparative, multicentre study.

METHOD

A previously published and validated tool was used with the addition of eight clinical scenario questions which were validated by an expert panel. Convenience sampling was used to select participants to form one cohort of newly graduated nurses (Cohort 1: n = 210) and a second cohort of nurses completing their intensive postgraduate clinical year (Cohort 2: n = 97).

RESULTS

Significant deficits relating to the theoretical factors that affect pulse oximetry application and interpretation were identified. Results suggest some knowledge is negatively correlated with clinical experience and that pregraduate university education appears to influence the ability to effectively apply pulse oximetry knowledge to clinical scenarios.

CONCLUSIONS

This study provides insight into pulse oximetry knowledge acquisition and deficits of graduate nurses which may inform pre- and postgraduate nurse education. In particular, it suggests that some pulse oximetry knowledge and clinical application of knowledge is not enhanced by clinical experience but rather is currently gained through pregraduate experiences.

RELEVANCE TO CLINICAL PRACTICE

Inappropriate utilisation and interpretation of pulse oximetry places patients at risk of mismanagement and undetected deterioration. Improvement in pregraduate education around the appropriate use of pulse oximetry may reduce clinical costs, reduce incidents of failure to rescue and improve patient outcomes.

Knowledge of pulse oximetry: comparison among intensive care, anesthesiology and emergency nurses

AIMS AND OBJECTIVES

To evaluate pulse oximetry knowledge of nurses employed in the Intensive Care Unit (ICU), Anesthesiology Department (AD) and Emergency Department (ED) and to compare knowledge among these departments/units.

BACKGROUND

Although pulse oximetry has been widely used in clinical practice, previous studies have reported knowledge deficits among nurses, which may adversely affect patient outcomes.

DESIGN

  Prospective, cross-sectional, multicentre study.

METHODS

All nurses employed in the ICU, AD and ED of six hospitals were asked to complete in private a 21-item, knowledge-evaluating questionnaire, which was evaluated for content-related validity and reliability.

RESULTS

Two hundred and seven questionnaires were completed (a response rate of 74·5%). Mean pulse oximetry knowledge score was 12·8 ± 3·2, with ICU nurses having significantly higher scores than ED nurses (p = 0·001) and those with more than 10 years of experience having significantly higher scores than less experienced ones (p = 0·015). Correct responses did not exceed 50% for six questionnaire items, five of which covered principles of pulse oximetry function. ICU nurses had significantly more correct responses in five items compared to ED nurses, and in two of them compared to AD nurses.

CONCLUSIONS

Longer professional experience and being employed in the ICU were associated with higher pulse oximetry knowledge of Greek nurses. Considering knowledge deficits and differences among nurses, pulse oximetry knowledge seems to mainly develop through clinical experience.

RELEVANCE TO CLINICAL PRACTICE

These findings highlight the need for pregraduate education to follow clinical advances, and especially for the implementation of high-quality, continuing education programmes to provide systematic learning and support professional development of nurses.

Comparison between a single-channel nasal airflow device and oximetry for the diagnosis of obstructive sleep apnea

RATIONALE

The most common single channel devices used for obstructive sleep apnea (OSA) screening are nasal airflow and oximetry. No studies have directly compared their role in diagnosing OSA at home.

STUDY OBJECTIVES

To prospectively compare the diagnostic utility of home-based nasal airflow and oximetry to attended polysomnography (PSG) and to assess the diagnostic value of adding oximetry to nasal airflow for OSA.

DESIGN

Cross-sectional study.

SETTING

Laboratory and home.

PARTICIPANTS

Sleep clinic patients with suspected OSA.

INTERVENTIONS

All patients had laboratory PSG and 2 sets of 3 consecutive nights on each device; nasal airflow (Flow Wizard, DiagnoselT, Australia) and oximetry (Radical Set, Masimo, USA) at home in random order.

RESULTS

Ninety-eight of the 105 patients enrolled completed home monitoring. The accuracy of nasal airflow respiratory disturbance index (NF RDI) was not different from oximetry (ODI 3%) for diagnosing OSA (area under the ROC curve (AUC) difference, 0.04; 95% CI of difference -0.05 to 0.12; P = 0.43) over 3 nights of at-home recording. The accuracy of NF RDI was higher after 3 nights compared to one night (AUC difference, 0.05; 95% CI of difference, 0.01 to 0.08; P = 0.04). Addition of oximetry to nasal airflow did not increase the accuracy for predicting OSA compared to nasal airflow alone (P > 0.1).

CONCLUSIONS

Nasal flow and oximetry have equivalent accuracy for diagnosing OSA in the home setting. Choice of device for home screening of sleep apnea may depend on logistical and service delivery issues.

Pulse oximetry knowledge and its effects on clinical practice

AIM

to explore literature pertaining to registered nurses' and/or doctors' knowledge in relation to the pulse oximetry in clinical practice.

BACKGROUND

pulse oximeters provide non-invasive readings of both pulse rate and peripheral oxygen saturation, leading to quick identification of potential/actual problems. Because of this, clinicians, like nurses, may become too dependent on it, neglecting other aspects of the holistic assessment process.

METHODS

a literature search was carried out between 1980 and 2006, with much of the data skewed towards 1994-2006. As the central focus was to be on pulse oximetry knowledge of nurses and/or doctors, articles included had to contain a central theme addressing this. Other criteria for inclusion were links between pulse oximetry and knowledge in clinical practice, nurses and/or doctors as participants in studies addressing this, as well as the clinical competency in relation to the device.

CONCLUSION

improving knowledge may not necessarily be the answer in improving clinical competency. Future research will need to be carried out to measure the connection between knowledge and competency and to use that as a basis for education and training.

Do clinicians know how to use pulse oximetry? A literature review and clinical implications

Pulse oximetry has become one of the most commonly used tools in the clinical environment for assessing patients' oxygenation status. It is employed almost continuously in critical care areas and frequently in the general ward environment. Although it is a much better tool for determining hypoxia than the human eye, its use is limited if clinicians do not understand relevant physiological principles, such as the oxyhaemoglobin dissociation curve and the inherent limitations of the device. Furthermore, the risk for compromised patient safety is significant if clinicians fail to recognise the potential for false or erroneous readings. This paper explores the research which has examined clinicians' comprehension of pulse oximetry. Fourteen studies examining clinicians' knowledge of pulse oximetry were reviewed. These studies revealed significant knowledge deficits about pulse oximetry amongst nurses, doctors and allied health professionals, all of whom used this technology frequently. Alarmingly, those lacking an adequate understanding of pulse oximetry included senior, experienced clinicians. The studies were limited by their use of convenience sampling and small sample sizes. Further research is needed to better understand the significance of this problem and to examine how principles of pulse oximetry are taught to nurses and other health professionals at the undergraduate and postgraduate levels. Educators and clinicians alike must ensure that a safe level of knowledge for the use of pulse oximetry is maintained in order to ensure that patient outcomes are not compromised.

Recent findings in the use of reflectance oximetry: a critical review

PURPOSE OF REVIEW

Pulse oximetry is ubiquitous but detailed understanding of the technology is poor. This is illustrated by publications addressing knowledge of pulse oximetry and those warning against the use of transmission pulse oximeter sensors in a reflectance manner, unintended by the manufacturers, owing to the potential for iatrogenic problems. Reflectance oximetry sensors are distinct and their application rather specific. Users must adhere to the manufacturer's guidelines to be assured of approximating the claimed accuracy and other specifications. Moreover, a thorough understanding of the device's shortcomings will optimize performance and avoid misuse. Cautious skepticism is appropriate with use of any technology but particularly with indirect measures of vital signs.

RECENT FINDINGS

The studies of reflectance sensors described here illustrate a diversity of successful applications and opportunities for further research. The genesis of applications for some sensors, for example fetal sensors, has proven helpful in other clinical settings where low mean arterial pressure and need for accurate monitoring of a SpO2 of less than 80% is poorly provided by transmittance sensors. Reflectance sensors are more prone to placement over contaminating sources (for example arteries and pigmentation), but their more sophisticated design can provide greater versatility than transillumination methods.

SUMMARY

This invited review highlights recent developments and applications of reflectance oximetry with an emphasis on the potential clinical and research advantages.