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Nursing

Continuous Electronic Monitoring

General Principles

Electronic monitoring is used by healthcare professionals as an adjunct to assessment and treatment. Monitors are not substitutes for nursing and physician assessment and care.

Indications for use

Continuous electronic monitoring is only indicated for patients who are at risk of an anticipated adverse event, and for whom knowledge of the change will result in an intervention. Continuous electronic monitoring is an adjunct to patient care when periodic vital sign monitoring does not provide frequent enough assessment and/or by providing an alert when the patient’s vital signs have deviated outside an identified acceptable range.

Alarms

The purpose of monitoring with alarms on the general wards is that warning of changing physiology will be given before irreversible untoward events occur.

False Alarms

Alarms that do not indicate a true change or deterioration in physiological status
False alarms must be differentiated from true alarms when an electronic monitor sounds frequently

Setting Alarm limits

By setting appropriate alarm limits you will be alerted to changes that you have assessed to be abnormal for a child.

Parameter

Lower Limit

Upper Limit

Oxygen Saturation

10% below baseline

100% unless otherwise indicated

Heart Rate

35% below baseline

50% above baseline

Respiratory Rate

25% below baseline

25% above baseline

Apnea

not applicable

20 seconds

If a Monitor Alarm Sounds…

  • Respond immediately
  • First assess the patient and determine if the patient requires any intervention; take manual vital signs as necessary
  • If the patient requires, attend to the needs as indicated and document relevant information - assessment, action taken and outcome
  • If the alarm was not triggered by a patient incident, check monitoring equipment and all connections, replacing electrodes (reposition as necessary), lead, or cable as required
    Contact Medical Engineering if the equipment is defective. Accurately and thoroughly complete the equipment repair tag and risk report as necessary, and send all components of the defective equipment to Medical Engineering (e.g. leads, cables)
Reference: SickKids Policies and Procedures: Vital Sign Monitoring