Impact of Innovative Pulse Oximeter Sensor Management Strategy

In 2002, a merger occurred between the Minneapolis Children's Medical Center and St. Paul Children's Hospital. Both hospitals had pulse oximetry monitors and equipment in place; however, they used two different oximetry sensor platforms. Minneapolis Children's used a multisite reusable sensor with a replacement tape and an accompanying sensor management plan, whereas St. Paul Children's used single-patient disposable adhesive sensors with a recycling/processing program.

Following the merger of the two hospitals, it became apparent to the new leadership team that the national trend was to adopt pulse oximetry as a standard of care in routine vital sign assessment. With this adoption, reimbursements decreased, and what was previously a revenue stream for the hospitals had become an operating expenditure. As a result, these financial disparities prompted leadership to initiate a capital project to standardize pulse oximetry with a focus on technology and cost containment.

The materials department assembled a team of key stakeholders to plan and facilitate the vendor selection process. Vendors submitted proposal requests and participated in product demonstrations, trials, and staff evaluations. The selected vendor partner offered state-of-the-art technology and a disposable sensor with a replaceable adhesive tape. The sensor life could be maximized by rejuvenating the adhesive with alcohol or by adding a new replacement tape (Figure 1).

In 2005, it was clear that the organization needed to address the ongoing increased costs and decreasing reimbursement associated with pulse oximetry. A value analysis team collected usage data showing that an average of 6.6 new pulse oximeter sensors were used for each patient during his/her stay. The team found a direct correlation in a unit's supply costs based on the ratio of single-patient oximetry sensors to replacement tapes used.

The value analysis team presented the prelaunch data to the organization's executive leadership and proposed a plan to revitalize the 2003 sensor management strategy of retaping instead of reprobing a single-use sensor on the same patient.

Leadership approved the revitalization of the sensor management strategy and set a 60% replacement tape–to–sensor usage goal for each care unit within the Pediatric and Critical Care Divisions. Usage data demonstrated that the largest percentage of single-patient adhesive sensor use occurred in these units (Figure 2).

In the course of reviewing the prelaunch data, the value analysis team noted that two of the 12 care areas within the Pediatric and Critical Care Divisions already had achieved and sustained the stated goal of 60% replacement tapes to sensors. This discovery presented the team with a challenge to determining why only two of the 12 care areas had sustained the cost-savings strategy implemented throughout the organization in 2003.

To further explore the reasons for this variable, meetings were scheduled with the managers and educators of each of the 12 care units and a logistical assessment of supplies and supply locations was performed. After these tasks were complete, the team reconvened to discuss findings. In the care areas that were out of compliance, the area's leaders cited that they were not aware of the initiative or it was seen as a low priority. It also was noted that the staff in these areas were using a new sensor with every application. When asked about reprobing, the team was informed that it was easier to replace the sensor because the sensors were available on the bedside cart and the replacement tapes were not readily available. The reverse was true in the two care areas that were complying with the strategy. In addition, the team determined that the current signage and supply locations were not optimal to reinforce the replacement tape strategy.

After these conversations, it was hypothesized that (1) the systems and practice put in place during the initial conversion were sound based on the results of the two units that achieved and sustained the 60% goal and (2) a lack of awareness and compliance to the standard seemed to be the deterrent to achieving and sustaining the goal in the other care areas. Based on the data, feedback, and the hypothesis, the team decided to focus on organizational communication and training to achieve the stated goal.

To achieve the 60% compliance goal, the team enacted the following action items to improve communication and training. The organization partnered with its pulse oximetry vendor to provide on-site, one-on-one staff education and super user training for the clinical educators and respiratory care staff. Following each training session, staff members were required to sign a roster to validate their participation and understanding of the training. This education was reinforced by attaching quick reference cards to the stand-alone pulse oximeters, adding procedural/educational material on the organization's intranet, and posting monthly utilization data with the cost of each supply adjacent to that supply in storage locations.

In addition, the sensor level was decreased to one and additional sensors were removed on all bedside supply carts. The level of replacement tapes also was increased and added to the carts. In further support of these initiatives, monthly status updates were provided via organizational newsletters, intranet articles, on-screen pop-ups, desktop screen savers, and email communications to leaders.

Upon achievement of the 60% compliance goal across all targeted areas, a decision was made to decrease the amount and frequency of direct communication; however, the online resources, quick reference cards, and supply cost signage were left in place. Ongoing education on this practice now is included as part of each new clinical employee's bedside orientation.

For this initiative, no special infection control or recycling practices are needed within our management strategy. Standard infection control practices for disposable and reusable equipment are used. The reapplication of the disposable sensor is limited to the same sensor on the same patient. Between patients, the oximeter is wiped down with an approved cleaning agent. For reusable equipment, the sensor and oximeter are wiped with an approved cleaning agent and, when applicable, a new adhesive tape is placed on the reusable sensor for the next patient. The tapes and single-use sensors are disposed of in regular waste containers—this is one of many reasons why the sensor management plan is more cost effective and easier to maintain compared with a standard recycling/processing program, which has special requirements for collection and disposal.

The replacement tape strategy has contributed to maximizing sensor life, reducing sensor costs, and decreasing medical waste. Children's Minnesota used more than 780,000 replacement tapes during a period of 12 years. The hospital staff continue to use the method of retaping instead of reprobing patients, thereby reducing the sensor footprint by one with every replacement tape used.

Every unit in the Pediatric and Critical Care Divisions has met or exceeded the 60% replacement tape–to–sensor usage goal. The sensor management plan has resulted in a cumulative cost avoidance of more than 7 million dollars and an overall reduction of more than 780,000 sensors and packaging for disposal between 2006 and 2019. When stacked up, the height of the total number of sensors that avoided landfill during a 12-year period is comparable to the height of Mt. Everest (Figure 3).

Based on ongoing data collection, leadership recognized further cost-savings opportunities in the emergency departments and outpatient clinics. In 2010, a strategy for the emergency department was developed, adding replacement tapes for single-use sensors and reusable sensors in the triage areas. Shortly thereafter, all outpatient clinics converted to reusable sensors.

Through this process, the team and organization have learned several lessons. First, establishing a strong multidisciplinary team with an engaged executive sponsor and project manager is important to providing the team with guidance and oversight throughout the process. An effective team should include representatives from clinical leadership, supply chain, quality, information technology services, and infection control, as well as frontline clinical staff.

Collecting, tracking, and analyzing data is important. If available, retrospective data can help the team in formulating an action plan. Live data are vital to charting the course from where you were to where you want to go.

Setting expectations and defining standard work also are important, and once established, the organization should not deviate from these standards. After targets and goals have been developed, a visual project plan with milestones should be created to track progress.

A template for formal and frequent communication also should be developed. A process should be set up for acknowledging when goals and milestones have been met. In the organization's communication vehicles, our team posted the data for all 12 units, which started a friendly competition among individual care areas to see who could achieve the highest monthly percentage.

A final lesson is to have patience and realize that projects such as these take time. Children's value analysis teams have learned by experience that good outcomes are achievable with positive reinforcement, communication, and support.

The practice of retaping sensors allows clinicians to recheck and reposition sensor sites frequently with minimal cost and difficulty. These strategies align and support key organizational patient safety and comfort goals. With the alternative of replacement tapes with single-use sensors, patient safety and comfort become a priority. Leaving the same sensor on a site for a longer period to avoid replacement is no longer an issue.

In this case study, leadership and staff quickly adopted the practice and found that replacement tapes were convenient and easy to use. The implementation of a novel sensor management plan maximized sensor life and substantially reduced sensor costs and medical waste.