The Post Anesthesia Care Unit at St. Jude Hospital in Fullerton, California is a 12 bay unit servicing on average forty surgeries per day. Standard monitoring includes three lead EKG, non-invasive blood pressure, pulse oximeter and respiratory rate. The PACU patient population range is from infancy to elderly and surgery focus on general surgery, orthopedics, gynecological, vascular and neurosurgery. The PACU is currently using Phillips brand Intellivue Monitoring system and has three CO2 monitoring extensions. St Jude is also using systems from Nellcor and Alaris which both have capnography capabilities.
Evidence base review of current medical research verifies that using pulse oximetry does not capture true measurement of ventilation. Pulse oximetry measures oxygenation not ventilation. Patients in the post operative period are at higher risk for hypoventilation and sedation from the combination of anesthesia and analgesic medications. Also the patient controlled analgesic (PCA) pumps are initiated in the PACU which can add to sedation and hypoventilation. The PACU nurse must make critical decision when medicating for pain and providing safety for the patient. Sometimes sedation comes before analgesia, the patient states high pain level but no relief, but they are progressively becoming more sedated. Using capnography can capture changes five minutes before the pulse oximeter shows decline (Cashman & Dolan, 2004). With the use of capnography the nurse will have the information needed to more accurately assess the patient and provide safe medication administration (Spikoff, 2006).
Task to be Accomplished
The clinical needs assessment of current equipment and practice reveals that the PACU needs a flexible capnography system that could monitor both intubated and non-intubated patients ranging in age from infancy to elderly. The PACU has only three modules in which to monitor capnography; education on using the module has been minimal and the end-tidal CO2 capability is not being utilized. The PACU nursing staff will require education on current standards and capnography monitoring. The capnography system must network with current computer charting system.
The PACU is currently using the Phillips Intellivue monitoring system. The Royal Phillips Electric Company of the Netherlands is a diversified health and well being company. The vision of Phillips is people focused, market driven company that is organized around its consumers and markets. In 2009 in adjustment to decrease sales of 19% Phillip started an aggressive $148 million reconstructing process (Electric). Phillips has a strong cash flow because of its reconstructing process. Phillips provides a mainstream CO2 extension for the multi-measurement server Intellivue. This extension can monitor both intubated and non-intubated patients and can be used wide age range from neonates to the elderly. Phillips provides online nursing education as well as a user guide book. The Phillip monitors in use are currently networked to computers and automatically downloads the vital signs to the patient computer chart.
St. Jude Medical Center is using Alaris infusion pump. Alaris is a division of Cardinal Health Care. Cardinal Health Care is an eighty-seven billion dollar global manufacturer and distributor of medical supplies and products. The vision of Cardinal Health Care is to be the premier global health care company who make health care safer and more productive. The Alaris division earned 2.7 million in revenue 2008, employs seven thousand people (Health C. ). The Alaris system is a state of the art infusion device which is has the Gaudrails safety software. Alaris is flexible wireless networking system which has extensions to monitor both pulse oximetry and Co2 levels. They combine these devices with the PCA pain pump to provide safety shut off if the patients CO2 level changes to unsafe level. The Alaris is flexible also in the fact that it can travel throughout the hospital stay since it is mounted on an infusion pole.
Nellcor is a division of Covidien which is a leading health care manufacturing company. Covidien earned 10 billion dollars of revenue in 2008 (Health C. ). The mission of Covidien can be summed up in four words: accountability, diversity, collaboration and compassion (Health C. ) Nellcor manufactures a handheld CO2 monitor NPB-70. The NPB-70 can be use for spot check monitoring or minimal monitoring; and can be used to monitor capnography for both intubated and non-intubated patients ranging in ages neonates to elderly. Nellcor has online education that provides nurse with continuing education credit. Nellcor also provides a loaner program when device is being serviced. The user manual is available on line as well as accessories to the device. The NPB-70 can be purchased with one, three and five year money back guarantee.
Cashman, J., & Dolan, S. (2004). Respiratory and hemodynamic effects of acute postoperative pain management: evidence from published data. British Journal of Anaesthesia , 212-223.
Electric, R. P. (n.d.). about us. Retrieved July 23, 2009, from Phillips sense and simplicity: http://www.philips.com/global/index.page
Health, C. (n.d.). about us. Retrieved July 22, 2009, from Cardinal Health: http://www.cardinal.com/us/en/aboutus/
Health, C. (n.d.). fact sheet. Retrieved July 22, 2009, from Covidien: http://www.covidien.com/covidien/pageBuilder.aspx?topicID=161272&page=AboutUs:CorporateFactSheet
Spikoff, M. (2006, July 24). Adding O2 and Co2 moitoring to PCA improves patient safety. Drug Source , p. 14.