Is Remote Patient Monitoring Just Another Nuisance Alarm?

Nick Pozderac

Remote Patient Monitoring on the MedSurg Floor

I worked in a hospital for more than a decade as a clinician. During that time, I often wondered what happens to medical-surgical patients being monitored in a private room, when the door was closed. What happens if a patient stops breathing? Or if the pulse oximeter dropped dangerously low? Or if the etCO₂ was trending high?

Would anyone be able to hear the alarm? Who would respond and what would happen to the patient? A decade ago, remote patient monitoring wasn’t really talked about. Not like it is today. But the question remains: Does remote patient monitoring save lives, or does it add to the continuum of alarms that providers listen to every day?

In this blog post, I’ll share with you a situation I experienced as a clinician that may provide some clarity to this question.

A patient’s story of Respiratory Compromise (RC)

After I transitioned from a clinician to working in the medical device industry, I encountered a patient who experienced adverse events due to undetected respiratory compromise (RC). Which is all too common.

I was part of a team that was completing the sale and installation of capnography monitors on a medical-surgical floor. The sale was to a midsized hospital with connectivity to a remote patient monitoring system.

Patients coming out of surgery first went to the PACU to be monitored for an hour or so. Then they were transported to the medical-surgical unit. If the patient was on a PCA pump, they’d go to the area that had capnography monitoring connected to the remote monitoring platform.

One day, I was invited into a patient’s room to support the nurse who was applying the capnography sampling line to the patient’s face. The nurse successfully applied the sampling line and told the patient why the capnography monitoring was necessary.

Over the next hour, the nurse called to inform me something was wrong with the monitor. I met the nurse outside the patient’s room. She explained that she’d received multiple notifications on her phone from the remote monitoring system that her patient had stopped breathing. But when she would check on the patient, he was wide awake.

I asked her to stand outside the patient’s room with me to observe. Everything happened exactly as she described, however, one important detail was overlooked. The patient closed his eyes, fell asleep, and stopped breathing. The patient’s sleep apnea happened several times while we were observing. Each time, the monitor’s capnography waveform would flatline and immediately the device would loudly alarm and wake him up. At the same time, the nurse received a notification on her phone from the remote monitoring system alerting her that the capnography monitor was alarming.

How continuous monitoring works

Here’s what was happening. The Capnostream™ 20p bedside capnography monitor alarmed immediately when the patient stopped breathing — just as it’s engineered to do. In fact, the monitor essentially helped to save the patient’s life every time he stopped breathing because the alarm woke him up.

The Capnostream™ 20p bedside capnography monitor delivers a broad range of respiratory status information and provides alarm management tools. It’s designed to help enhance patient safety and clinical outcomes by offering early indication of RC.

The monitor incorporates multiple smart alarm algorithms within the technology. Two of these algorithms are the Smart Breath Detection™ algorithm (SBD) and the Smart Alarm Respiratory Analysis™ algorithm (SARA).

The SBD algorithm is a proprietary filter and pattern recognition algorithm that screens out low-amplitude “nonbreath” etCO₂ excursions including snoring, talking, or crying. This provides a more reliable respiratory rate. Combined with the SBD algorithm, the SARA algorithm manages breath-to-breath variability. Together, the algorithms help reduce the number of nuisance alarms while simultaneously providing a comprehensive picture of respiratory status.

The Capnostream™ 20p bedside capnography monitor connects directly with the Vital Sync™ system, which is a remote patient monitoring system. This connectivity is designed to help you gain greater value from your medical devices and respond proactively to your patients’ needs. The Vital Sync™ system consolidates critical patient information from bedside devices and transmits it to your hospital server. So you can provide enhanced clinical care with immediate access to smart, actionable data. You can also view patient physiological information remotely and receive updates and alerts on any web-enabled device.

Continuous monitoring helps clinicians reduce and prevent RC

RC is a rapid decline in respiratory function that can lead to respiratory failure or death if left unaddressed.¹And it’s also common. In fact, up to 41 percent of patients suffer from some sort of RC.²Part of the trouble is it’s often unrecognized. Up to 50 percent of patients with respiratory distress have experienced delayed interventions. ³Continuous monitoring of pulse oximetry and capnography provide important indicators to changes in oxygenation and ventilation, two key factors in identifying RC early.

This patient case demonstrates how continuous monitoring, in combination with remote patient monitoring, can be a helpful tool for clinicians to save lives. Addressing RC begins with detecting it — so the earlier the better.

References
1. Morris TA, Gay PC, MacIntyre NR, et al. Respiratory compromise as a new paradigm for the care of vulnerable hospitalized patients. Respir Care. 2017;62(4):497–512.
2. Overdyk FJ, Carter R, Maddox RR, Callura J, Herrin AE, Henriquez C. Continuous oximetry/capnometry monitoring reveals frequent desaturation and bradypnea during patient-controlled analgesia. Anesth Analg. 2007;105(2):412–418.
3. Quach JL, Downey AW, Haase M, Haase-Fielitz A, Jones D, Bellomo R. Characteristics and outcomes of patients receiving a medical emergency team review for respiratory distress or hypotension. J Crit Care. 2008;23(3):325–331.

TOPICS: Microstream™ Capnography, Vital Sync™, Medical-Surgical