American Academy of Nursing

View all recommendations from this society

April 19, 2018

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

Nurses use continuous electrocardiography (ECG), respiratory, and pulse oximetry monitoring to track patient vital signs and trends, and to help identify signs of patient status deterioration. However, when pulse oximetry and physiologic monitoring are used inappropriately, significant cost burdens can affect the entire healthcare system. In addition, the high number of alarm alerts and level of noise created by these alarms leads 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.


These items are provided solely for informational purposes and are not intended as a substitute for consultation with a health professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician or nurse.

How The List Was Created

The American Academy of Nursing has convened a workgroup of member fellows who are leaders of professional nursing organizations representing a broad range of clinical expertise, practice settings and patient populations. The workgroup collaboratively identifies nursing/interdisciplinary interventions commonly used in clinical practice that do not contribute to improved patient outcomes or provide high value. An extensive literature search and review of practice guidelines is conducted for each new proposed recommendation for the list. The supporting evidence is then reviewed by the respective nursing organization(s) with the most relevant expertise to each recommendation. The Academy workgroup fellows narrow the recommendations through consensus, based on established criteria. The final recommendations are presented to the American Academy of Nursing’s Board of Directors for approval to be added to the Choosing Wisely list created by the Academy.

The American Academy of Nursing’s conflict of interests and disclosures policy can be found at www.AANnet.org.

Sources

Fuijkschot, J., Vernhout, B., & Lemson, J., Draaisma, J.,. (2015). Validation of a Paediatric Early Warning Score: first results and implications of usage. European Journal of Pediatrics, 174(1), 15-21. doi:10.1007/s00431-014-2357-8.

Gazarian, P. K. (2014). Nurses’ response to frequency and types of electrocardiography alarms in a non-critical care setting: a descriptive study. Int J Nurs Stud, 51(2), 190-197. doi:10.1016/j.ijnurstu.2013.05.014.

Karnik, A., Bonafide, C.P. (2015). A framework for reducing alarm fatigue on pediatric inpatient units. Hospital Pediatrics, 5(3), 160-163.

Murray, J. S. W., L.A.; Pignataro, S.; Volpe, D. (2015). An integrative review of pediatric early warning system scores. Pediatric Nursing, 41(4), 165-174.

Sendelbach, S., Wahl, S., Anthony, A., & Shotts, P. (2015). Stop the Noise: A Quality Improvement Project to Decrease Electrocardiographic Nuisance Alarms. Crit Care Nurse, 35(4), 15-22; quiz 11p following 22. doi:10.4037/ccn2015858.

Watkins, T., Whisman, L., & Booker, P. (2016). Nursing assessment of continuous vital sign surveillance to improve patient safety on the medical/surgical unit. J Clin Nurs, 25(1-2), 278-281. doi:10.1111/jocn.13102