Can End-tidal CO2 (ETCO2) monitoring be used as a tool for detecting hypoventilation and over-sedation in Post Anesthesia Care Unit (PACU)? An internal environment evaluation was obtained by using a three question evaluation tool. See following page to view questions figure 1. Four Staff members were interviewed: Manager of PACU, shift Coordinator, and two Anesthesiologist. Results as follows:
Name Question 1 Question 2 Question 3
Manager yes no no
Shift Coordinator yes no no
Anesthesiologist 1 no no yes
Anesthesiologist 2 no no no
It was discovered that the Anesthesiologist are unaware of any sentinel events which showed that the reporting system does not include the Anesthesia department. The Manager and Shift Coordinator were both aware of events that occurred because of over sedation/hypoventilation. All agree that using pulse oximeter only detects oxygen saturation and can not be used to evaluate ventilation. Only one person interviewed was aware of current trends in using ETCO2 in other settings outside intensive care units.
The goal or vision of using ETCO2 will be that patients are monitored for ventilation (not just oxygenation) and increase patient safety.
PACU uses the Phillips Intellivue Monitor which has the capability to monitor ETCO2 using side stream nasal filter line for non-intubated patients. The PACU stocks three modules and three different sizes of nasal filters. The Respiratory department has portable bedside capnography/pulse oximeter which can be used as a one time spot check or for continuous monitoring. Exploration of the use of ETCO2 monitoring would need to include stake holders from the general surgeon, anesthesiologist, manager, staff nurses, respiratory therapist, and education department. It is evident that the capability to use ETCO2 is available on a limited basis because of so few monitoring devices are available. Organizational needs are: identifying and reporting sentinel events, education and training on using ETCO2 monitor, deciding which group of clients would be best served monitoring ETCO2 (post operative patients using patient controlled analgesics), and evaluating and choosing device.
Lessons learned from the past included not identifying all the stake holders and making changes without a full educational plan. The phasing for this project will include: gathering data of sentinel events to help define the problem, meeting with stake holders to share evidence based research, choose best device, designing educational plan, implementing the use of ETCO2, and evaluating the effectiveness of ETCO2.
ETCO2 Internal Questionnaire (fig.1)
Question Yes No N/A
Are you aware of a sentinel event cause by over sedation/hypoventilation post-operatively?
Can pulse oxiemtry measure or detect over sedation/hypoventilation?
Can ETCO2 monitoring be used as a tool to detect or prevent over sedation/hypoventilation in post operative patient?