Barriers and Facilitators to Guideline-Adherent Pulse Oximetry Use in Bronchiolitis.

Abstract

Continuous pulse oximetry monitoring (cSpO₂) in children with bronchiolitis does not improve clinical outcomes and has been associated with increased resource use and alarm fatigue. It is critical to understand the factors that contribute to cSpO₂ overuse in order to reduce overuse and its associated harms. This multicenter qualitative study took place in the context of the Eliminating Monitor Overuse (EMO) SpO₂ study, a cross-sectional study to establish rates of cSpO₂ in bronchiolitis. We conducted semistructured interviews, informed by the Consolidated Framework for Implementation Research, with a purposive sample of stakeholders at sites with high and low cSpO₂ use rates to identify barriers and facilitators to addressing cSpO₂ overuse. Interviews were audio recorded and transcribed. Analyses were conducted using an integrated approach. Participants (n = 56) included EMO study site principal investigators (n = 12), hospital administrators (n = 8), physicians (n = 15), nurses (n = 12), and respiratory therapists (n = 9) from 12 hospitals. Results suggest that leadership buy-in, clear authoritative guidelines for SpO₂ use incorporated into electronic order sets, regular education about cSpO₂ in bronchiolitis, and visual reminders may be needed to reduce cSpO₂ utilization. Parental perceptions and individual clinician comfort affect cSpO₂ practice. We identified barriers and facilitators to deimplementation of cSpO₂ for stable patients with bronchiolitis across children's hospitals with high- and low-cSpO₂ use. Based on these data, future deimplementation efforts should focus on clear protocols for cSpO₂, EHR changes, and education for hospital staff on bronchiolitis features and rationale for reducing cSpO₂.