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Practice Problem: Infants and children are a vulnerable patient population at an inherently higher risk of detrimental effects of hypoxia or hypoxemia. Literature shows that early detection of hypoxemia can facilitate timely interventions which in turn can reduce morbidity and mortality. On an inpatient pediatric pulmonary unit, there have been multiple instances of staff concern for inaccurate pulse oximetry readings, leading to evaluation of potential technological interventions to improve early detection of hypoxia. In one year, there were 3 code/MET events, in which uncertainty of device accuracy delayed response time and interventions. To address this problem, an evidence-based practice project was implemented using the PICOT question: In respiratory technology dependent pediatric patients (P), how does alternative oximetry monitoring (I) compared to current oximetry monitoring (C) affect early notification of decreased oxygen saturation (O)? A different type of pulse oximetry device was evaluated to determine if pulsatile signal tracking technology would improve early detection of decreased oxygen saturation. Detection of low oxygen saturation earlier allows for quicker interventions, improving overall patient safety and outcomes. Literature/Evidence: A comprehensive literature search using Children’s Health Library, Medline, and Scopus databases was conducted using key terms including pulse oximetry, pediatric, hypoxia, arterial, and accuracy. The search yielded 24 articles including systematic reviews and randomized controlled trial. Literature suggests that overestimation of oxygen saturation by pulse oximeters, particularly in hypoxic states, is higher in darker pigmented skin tone or states of lower perfusion. Readings may also be influenced by factors such as the method of oxygen saturation measurement (e.g., venous versus capillary). On the inpatient pediatric pulmonary unit, 76% of the patient population during 2025–2026 is Hispanic or African American which correlates with darker pigmented skin, making this an important consideration when interpreting pulse oximetry measurements. Practice Change(s): The practice change was focused on an inpatient technology dependent pulmonary unit staffed with both core nursing and respiratory therapists. Prior to pilot, meetings with organization value analysis representatives, nursing leadership, vendors for pulse oximetry, and physiological monitor representatives determined how best to compare current pulse oximeter to trialed pulse oximeter. Key stakeholders and nursing leaders supported pilot. Both the existing pulse ox and piloted pulse ox remained in place for the duration of pilot to ensure appropriate monitoring and connection to electronic medical record documentation. Implementation/Pilot Testing: A total of ten patients were included in pilot with side-by-side comparison of both products over a five-day period. Inclusion patients had darker pigmented skin, and baseline lower perfusion with a variety of complex pulmonary diagnosis, including bronchomalacia, pulmonary hypertension, restrictive lung disease, obstructive sleep apnea, and bronchiolitis. The respiratory support for patients ranged from non-invasive bi-level positive pressure and continuous positive pressure ventilation, tracheostomy and ventilator dependent, heated trach collar, and heated high flow nasal cannula. Outcomes/Results: Side by side comparison included recording minute by minute oxygen saturation and heart rate from both devices. Both nurses and respiratory therapists were surveyed during pilot with 45 total responses. Respondents had 89% confidence that piloted pulse oximeter correlated with other clinical signs/symptoms, 60% had confidence of piloted pulse oximeter accuracy, with an overall 53% product preference. The bedside staff recorded and/or time stamped desaturation event details, that allowed review of minute-by-minute data. These results indicated that the piloted pulse oximeter picked up desaturations and responded to clinical interventions quicker than current pulse oximeter. In addition, the heart rate detected by the piloted pulse oximeter correlated consistently with heart rate detected by electrocardiogram (ECG) leads and two occasions with exact correlation to blood gas O2 saturation value. Recommendations/Conclusions: While this pilot was limited by its small sample size and short duration, the results support expansion of pilot to gather data in critical care settings. Next steps include expanded pilot and evaluation of piloted pulse oximeter for system use.
Publication Date
10-17-2026
Disciplines
Pediatric Nursing
Recommended Citation
Reyna, Christina, "Pulse (Ox) Check! Smarter Monitoring, Stronger Outcomes" (2026). EBP Fellowship. 26.
https://scholarlycollection.childrens.com/nursing-posters-tcuebp/26
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This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.
