Affecting outcomes for critical care patients

While taking care of a patient, Danielle Hlavin had a lightbulb moment.

Her care team was having a hard time getting a pulse oximeter reading on a patient’s finger. As a common practice, the next best location was to put the finger probe on the patient’s earlobe.

Hlavin, an ICU charge nurse at UCHealth Memorial Hospital Central, noticed that the patient’s clinical presentation wasn’t matching the earlobe pulse oximeter number. Out of curiosity, she put the probe back on the patient’s finger where it presented a different number. When the finger pulse ox number was addressed, the patient’s clinical presentation was matching.

Concerned about the off-label use of pulse ox probes, Hlavin asked more questions. Should providers continue using finger pulse ox probes on an earlobe? What are the limitations of pulse oximetry and is it widely known how it can affect accuracy?

Hlavin did a deep dive into the literature and even reached out to the product representative. She learned that finger probes are designed to account for bone. So, using a finger probe on an earlobe can over-estimate oxygen levels.

Knowing this information would have a direct impact on patient care, Hlavin completed a UEXCEL project and subsequent Nursing Research Fellowship on the topic.

Her UEXCEL project, a quality improvement initiative in the ICUs at Memorial Central and Memorial North, involved educating nurses and securing 90 earlobe probes, specifically designed for the ear. Pre-intervention, 15% of patients in the ICU had a finger probe on their earlobe. Whereas post-intervention, that percentage came down to less than 1%.

With education and the right tools, the ICUs showed a significant decrease in off-label use of pulse ox probes, thereby improving patient outcomes. In an effort to gain more evidence, Hlavin applied for and was accepted into the Nursing Research Fellowship, FY2021 cohort.

This UCHealth-wide fellowship is an 18-month, structured and mentored program created to guide clinical nurses through the research process to advance nursing knowledge and improve patient care.

Hlavin is completing a study comparing the SpO2 (oxygen saturation) from a finger probe on the finger, a finger probe on the ear, an ear probe on the ear, and an ear probe on the nose. She compares those measurements to the SaO2 (arterial oxygen saturation) from the blood. Ideally, the goal is for the external number, SpO2, to match the internal number, SaO2, for an accurate measurement.

Hlavin’s UEXCEL quality improvement project has been successfully implemented in the ICU at Memorial Central and Memorial North. With the additional evidence from her Nursing Research Fellowship, she hopes to begin a level 4 project which would share this insight to other regions and other departments, system-wide. She hopes this research will be published twice, once for the UEXCEL project and again for the Nursing Research Fellowship.

“I’m really glad I did both the UEXCEL project and Nursing Research Fellowship,” Hlavin said. “I really enjoy being at the top of my game and knowing how to provide the best care for patients. And making sure that we’re all providing that same best care.”