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Clinical Decision Support for Pediatric Home Pulse Oximetry Orders
  • +4
  • Heidi Herrick,
  • Meghan McNamara,
  • Kimberly Albanowski,
  • Erin Pohl,
  • Sara B. DeMauro,
  • Christopher Bonafide,
  • Naveen Muthu
Heidi Herrick
University of Pennsylvania Department of Pediatrics

Corresponding Author:herrickh@chop.edu

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Meghan McNamara
The Children's Hospital of Philadelphia
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Kimberly Albanowski
The Children's Hospital of Philadelphia
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Erin Pohl
The Children's Hospital of Philadelphia
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Sara B. DeMauro
University of Pennsylvania Department of Pediatrics
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Christopher Bonafide
University of Pennsylvania Department of Pediatrics
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Naveen Muthu
Emory University Department of Pediatrics
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Abstract

Objective: Home pulse oximetry is often prescribed to children with chronic disease upon hospital discharge. Children monitored at home may generate >20 alarms every 8 hours, contributing to premature discontinuation of monitoring. We aimed to improve the home oximetry ordering process using clinical decision support (CDS), supporting more liberal oxygen saturation (SpO 2) alarm limits. Methods: Within a large single-center improvement project to increase informativeness of alarms in the hospital and in patients’ homes, we compared home care oximetry orders of discharged children pre-post CDS implementation. Order parameters included low SpO 2 limit, specification of intensity of use, an intervention plan, pulse oximetry probe prescription, and order completeness. We extracted order details 6 months pre-CDS and 6 months post-CDS with a one-month washout period. The CDS intervention used a letter template to include all required home oximeter order elements and provide more liberal age-specific default alarm limits. Results: There were 100 orders in the pre-CDS epoch (7/1/2021-12/31/2021) and 112 orders in the post-CDS epoch (2/1/2022-7/31/2022). The median low SpO 2 alarm limit post-CDS implementation (87%, IQR 87%-90%) was significantly lower than pre-CDS (90%, IQR 90%-90%, p=<0.001). In the post-CDS epoch significantly more orders included an intervention plan (80.4% versus 31%, p<0.001), prescribed pulse oximeter probes (85.7% versus 52.0%, p<0.001), and were complete (68.8% versus 13.0%, p<0.001). Conclusions: CDS implementation resulted in a significant decrease in median low SpO 2 limit and a significant increase in home oximetry order completeness. These changes may decrease home oximetry alarm burden and improve caregiver experiences with home oximetry.