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Parental Insights into Improving Home Pulse Oximetry Monitoring in Infants
Daria F Ferro1,2,3, Christopher P Bonafide1,2,3,4, Nicole Fregene5
1Sections of Pediatric Hospital Medicine and Clinical Informatics, Division of General Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia, Pa.
Insights
Home pulse oximetry monitoring for infants often leads to false alarms, causing caregiver stress and unsafe practices. Parents develop workarounds, including stopping monitoring, highlighting the need for system re-engineering.
Area of Science:
- Pediatric healthcare quality improvement
- Biomedical engineering in home care
- Family-centered care systems
Background:
- Home pulse oximeters for infants with cardiorespiratory issues frequently produce false alarms.
- These alarms cause caregiver stress, sleep disruption, and potentially unsafe practices.
- The interplay between oximeters, alarms, and daily family life is poorly understood.
Purpose of the Study:
- To explore parent perspectives on home pulse oximetry monitoring.
- To inform a quality improvement initiative by understanding user challenges.
- To identify factors contributing to false alarms and caregiver burden.
Main Methods:
- Purposive sampling and in-depth interviews with parents of infants using home pulse oximeters.
- Utilized systems engineering frameworks to guide interview questions.
- Employed iterative coding with deductive and inductive analysis of qualitative data.
Main Results:
- Parents reported significant dissatisfaction with false alarms, mainly due to probe issues and infant movement.
- Poor device design (tones, portability) created substantial family burdens, impacting sleep, mobility, and social life.
- Parents universally developed coping strategies, including discontinuing monitoring, to manage device-related challenges.
Conclusions:
- Home pulse oximetry presents considerable challenges for families, potentially compromising infant safety.
- Current monitoring compliance recommendations may be impractical for caregivers.
- Re-engineering the home monitoring system with a family-centered approach is recommended for improved outcomes.
Abstract:
Home pulse oximeters prescribed for infants with cardiorespiratory conditions generate many false alarms, which create caregiver stress and sleep disturbance and can lead to unsafe practices. Additionally, relationships among oximeters, alarms, and everyday living demands are not well understood. Therefore, we aimed to gather parent perspectives on home pulse oximetry monitoring during the problem analysis phase of a quality improvement (QI) initiative.
Methods:
We purposively sampled and interviewed parents of infants prescribed home pulse oximeters and receiving local home care company services. We based questions on systems engineering frameworks previously used in healthcare. Data were coded iteratively and analyzed deductively (theoretical frameworks) and inductively (emerging themes).
Results:
Generally, themes aligned with theoretical frameworks. Parents expressed dissatisfaction with the number of false alarms home pulse oximeters generate, which parents primarily attributed to poor probe adhesiveness and the inability of oximeters to account for infant movement. Interviews highlighted the burden associated with poor device tones and portability. Device-related issues had negative repercussions for the entire family related to sleep quality, mobility, and social interactions. Universally, parents developed workarounds, including cessation of monitoring.
Conclusions:
Parents of infants monitored at home using pulse oximetry face many challenges, resulting in compromises in safety. Continuing to instruct parents to comply with prescribed monitoring recommendations may be unrealistic. Instead, we suggest re-engineering the home monitoring system with the needs and goals of children and their families at the center. Our description of adapting qualitative research and systems engineering methods may benefit others developing QI work.
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