Present Standard of Care for Post-operative Patients

Receiving Opioids

On post-operative floors pulse oximetry is usually not continuously monitored.  Instead, by far the most common practice is to "spot-check" patients every 4-6 hours along with routine checks of blood pressure, pulse, respiratory rate and temperature.  This routine practice most often results in awakening patients. After awakening patients quite often the result is an increase in both blood pressure and SpO2.  Commonly nurses will wait for the best obtainable SpO2 reading, which will rise with awakening.

In between the spot-checks Cleveland Clinic researcher Daniel Sessler (References) found that prolonged and alarmingly low SpO2 was common.  These periods of hypoxemia were undetected by the usual intermittent checks and disturbingly, the SpO2 values recorded in the medical record were often the values found after awakening patients and waiting for SpO2 to maximize.

The Current Standard of Care in post-operative patient SpO2 surveillance:

1.  Long periods of severe hypoxemia are commonly missed.

2.  SpO2 values recorded in the medical record do not reflect what happens

     between awakenings and are actually misleadingly optimistic.

3.  Episodic monitoring of SpO2 cannot minimize harm from low SpO2.

4.  Patients in the ER, post-op recovery areas and after Special Procedures

     who receive opioids are always continuously monitored with pulse oximetry

     while only about 10% on post-op floors receive the same level of

     surveillance during their opioid therapy--that is, post-op patients are NOT 

     monitored continuously 90% of the time. 

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