To describe the impact on nursing practice of using continuous pulse oximetry monitoring to monitor patients at high risk for respiratory depression after surgery.
A convergent mixed method design.
Thirty (30) hours of non-participant structured observation and explanatory interviews were conducted with 10 nurses from the surgery care unit and intensive care unit.
We found that nursing practice to evaluate and monitor at-risk patients through continuous pulse oximetry monitoring is mainly linked to technical care. Nurses generally meet the frequency of bedside monitoring required by established protocols. During the structured non-participant observation periods, it was observed that 90% of the alarms were false (unsustained desaturations). This was confirmed by the nurses during the explanatory interviews. Noisy environments, high number of false alarms, poor communication between nurses and various operational failures might have a negative impact on nursing practice.
Several challenges must be overcome for this technology to achieve the desired outcomes of continuous surveillance and rapid detection of respiratory depression episodes for post-surgical patients. No Patient or Public Contribution.

OBJECTIVE: To provide a framework to assess and evaluate nursing surveillance of patients.
BACKGROUND: The Nursing Interventions Classifications define surveillance as the purposeful and ongoing acquisition, interpretation, and synthesis of patient data for clinical decision making and is essential for improving patient safety.
METHODS: The existing literature was searched using CINAHL, OVID, EmCare, and 11 ScienceDirect databases.
METHODS: The Walker and Avant method was used to analyze the concept of surveillance.
RESULTS: Technology that facilitates surveillance in the community is ubiquitous in acute care settings. Nurses caring for patients use a tremendous volume of patient data to inform their clinical decision-making. Five attributes are associated with nursing surveillance: systematic process, pattern recognition, coordinated communication, the anticipation of problems of instability, and decision making. Surveillance is dynamic and extends over time. Antecedents to nursing surveillance include sufficient nurse education, nurse expertise, nurse staffing, as well as an organizational culture that supports nursing surveillance. When nursing surveillance is present, patient safety is enhanced and adverse events that harm patients are reduced. The concept of nursing surveillance is complex and defies empirical measurement, though it is possible to measure the attributes and outcomes.
CONCLUSIONS: Nursing surveillance is essential to the safe management of complex patient cases. Surveillance is more than monitoring or simple patient observation. Monitoring is an essential part of surveillance but incorporating the critical attributes of surveillance lead to improved patient outcomes.

OBJECTIVE: To determine consensus across acute care specialty areas on core physical assessment skills necessary for early recognition of changes in patient status in general wards.
BACKGROUND: Current approaches to physical assessment are inconsistent and have not evolved to meet increased patient and system demands. New models of nursing assessment are needed in general wards that ensure a proactive and patient safety approach.
METHODS: A modified Delphi study.
METHODS: Focus group interviews with 150 acute care registered nurses at a large tertiary referral hospital generated a framework of core skills that were developed into a web-based survey. We then sought consensus with a panel of 35 senior acute care registered nurses following a classical Delphi approach over three rounds. Consensus was predefined as at least 80% agreement for each skill across specialty areas.
RESULTS: Content analysis of focus group transcripts identified 40 discrete core physical assessment skills. In the Delphi rounds, 16 of these were consensus validated as core skills and were conceptually aligned with the primary survey: (Airway) Assess airway patency; (Breathing) Measure respiratory rate, Evaluate work of breathing, Measure oxygen saturation; (Circulation) Palpate pulse rate and rhythm, Measure blood pressure by auscultation, Assess urine output; (Disability) Assess level of consciousness, Evaluate speech, Assess for pain; (Exposure) Measure body temperature, Inspect skin integrity, Inspect and palpate skin for signs of pressure injury, Observe any wounds, dressings, drains and invasive lines, Observe ability to transfer and mobilise, Assess bowel movements.
CONCLUSIONS: Among a large and diverse group of experienced acute care registered nurses consensus was achieved on a structured core physical assessment to detect early changes in patient status.
CONCLUSIONS: Although further research is needed to refine the model, clinical application should promote systematic assessment and clinical reasoning at the bedside.

BACKGROUND: Continuous pulse oximetry monitoring is recommended to improve safety during postoperative opioid use, however concerns with monitoring on general care units remain, given potential system barriers to alarm transmission, recognition, and nursing response.
METHODS: This prospective, observational study evaluated unit and hospital-level factors affecting nurses\' response to monitor desaturation alarms in postoperative patients on a general postoperative unit. With exemption and waiver of consent granted from the Institutional Review Board, monitoring data were downloaded from bedside monitors of postoperative patients. Alarm notification data and response times were recorded from the continuous capture of institutional surveillance data. Paging notifications were coded as clinically relevant (i.e., true oxygen desaturation with SpO2<89 for >15s) or irrelevant (i.e., artifact, inappropriate alarm threshold, or failure to delay page). Linear mixed models, and correlation coefficients were used to examine the relationships between unit staffing, shift, paging burden and response time. Means and [95% confidence intervals] are presented.
RESULTS: 1616 monitoring hours in 103 patients yielded 342 desaturation events (duration 23.6s [20.99, 26.1]) and 710 notification pages, 36% of which were for clinically relevant desaturation. Nursing response time was 52.1s [46.4, 57.7], which was longer at night (63.8 [51.2, 76.35]; p=0.035), but not related to unit staffing. Missed alarm events (i.e., no notification page transmitted) occurred for 26% of the clinically relevant events, and were associated with higher paging burden (p=0.04), lower SpO2 values (81.8 [80.5, 83.0] vs. 83.2 [82.6, 83.8]; p=0.026), and higher odds of intervention (OR 3.5 [1.38, 8.9]). 65% of patients with desaturation events received interventions which correlated with the number of pages (rho=0.422; p<0.01) and events (rho=0.57; p<0.01), desaturation duration (rho=0.505; p<0.01), and SpO2 (rho=-0.324; p<0.01).
CONCLUSIONS: One-third of pulse oximetry alarm notifications were for clinically relevant oxygen desaturation, facilitating timely nursing response and intervention for most patients. Unit staffing and false alarm frequency were not associated with response time, suggesting a high level of attention on this unit. The nature and degree of missed alarm events suggests patient safety concerns posed by hospital-level transmission systems warranting further strategies to ensure monitoring safety.