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. 2022 Jan;57(1):209-216.
doi: 10.1002/ppul.25722. Epub 2021 Oct 18.

Home pulse oximetry after discharge from a quaternary-care children's hospital: Prescriber patterns and perspectives

Julie Fierro  1 , Heidi Herrick  2   3 , Nicole Fregene  3 , Amina Khan  4 , Daria F Ferro  2   5 , Maria N Nelson  2 , Canita R Brent  5 , Christopher P Bonafide  2   5 , Sara B DeMauro  2   3
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Home pulse oximetry after discharge from a quaternary-care children's hospital: Prescriber patterns and perspectives

Julie Fierro et al. Pediatr Pulmonol. 2022 Jan.

Abstract

Introduction: Pulse oximetry monitoring is prescribed to children receiving home oxygen for chronic medical conditions associated with hypoxemia. Although home pediatric pulse oximetry is supported by national organizations, there is a lack of guidelines outlining indications and prescribing parameters.

Methods: A mixed-methods analysis of pediatric home pulse oximetry orders prescribed through the institutional home healthcare provider at a large US children's hospital 6/2018-7/2019 was retrospectively reviewed to determine prescribed alarm parameter limits and recommended interventions. Semi-structured qualitative interviews with pediatric providers managing patients receiving home oxygen and pulse oximetry were conducted to identify opportunities to improve home pulse oximetry prescribing practices. Interviews were analyzed using a modified content analysis approach to identify recurring themes.

Results: A total of 368 children received home pulse oximetry orders. Orders were most frequently prescribed on noncardiac medical floors (32%). Attending physicians were the most frequent ordering providers (52%). Frequency of use was prescribed in 96% of orders, however, just 70% were provided with specific instructions for interventions when alarms occurred. Provider role and clinical setting were significantly associated with the presence of a care plan. Provider interviews identified opportunities for improvement with the device, management of alarm parameter limits, and access to home monitor data.

Discussion: This study demonstrated significant variability in home pulse oximetry prescribing practices. Provider interviews highlighted the importance of the provider-patient relationship and areas for improvement. There is an opportunity to create standardized guidelines that optimize the use of home monitoring devices for patients, families, and pulmonary providers.

Keywords: bronchopulmonary dysplasia; chronic lung disease; home monitoring; home oxygen therapy; pediatrics; pulse oximetry.

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