American Association of Neuroscience Nurses, Society of Pediatric Nurses & American Pediatric Surgical Nurses Association, Inc.

View all recommendations from this society

December 1, 2022

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

(1–5 & 8) Members of the American Association of Neuroscience Nurses formed a task force to review evidence and make a recommendation of 5–10 things nurses should tell neuroscience patients to consider. AANN’s Special Focus Groups, which are composed of subject matter experts in various subspecialties of neuroscience, were consulted to help identify topics and provide supporting evidence. The task force reviewed the items for possible inclusion to determine the top recommendations. The top recommendations were presented to the AANN Board for review and approval.

(6) SPN initially reached out to several subject matter experts to learn about topic areas where they were aware of both evidence of overuse of health care resources and evidence-based resources to support addressing that overuse. SPN then chose two experts with research experience within the topic area we identified. One served as the main author while the other served as the reviewer. After the initial review was completed, we shared the content with the SPN Board of Directors for further input. Finally, colleagues at the American Academy of Nursing provided a final review.

(7) Once the American Pediatric Surgical Nurses Association, Inc. (APSNA) received an invitation from the Institute of Pediatric Nursing (IPN) to participate in the initiative, the APSNA Board was queried to identify pediatric nursing practices that should be modified based on evidence. The identified practice was presented to experts from APSNA’s Board of Directors, General Membership and Trauma Special Interest Group (SIG). The preliminary statement was reviewed and revised by content experts from both within and outside of the organization. Subsequently, the statement was submitted to the APSNA Board for final discussion and review. The final statement was reviewed and approved by the American Academy of Nursing.

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