Q: Are physician's orders required to perform pulse oximetry in home care settings? Physician's are objecting to having to sign orders when the procedure is not invasive. They equate this to a nurse taking a blood pressure.
A: A physician's orders for the use of pulse oximetry is required for the following reasons:
- There are several factors that support the involvement of a physician in the use of pulse oximetry. For example, the procedure is not without risk to the patient, the indications and contraindications for use need to be clearly related to the assessment and monitoring needs of the patient, staff need to be trained in the use and interpretation of findings and need to be available, and the results of oximetry need to be validated to overcome device limitations.
- The American Association for Respiratory Care and other professional groups believe that pulse oximetry should not be performed without a physician's order.
- The Joint Commission has received confirmation from the FDA that currently a patient specific order from an "authorized" individual is required for the use of pulse oximetry in the home care setting. Who can be considered an "authorized" individual, i.e., physician, dentist, nurse practitioner, physician's assistant, etc, is determined by applicable state law and regulation.
Pulse oximetry is used in many care settings. A physician's order may not be needed in all such settings. For example, pulse oximetry is a standardized component of monitoring oxygenation of patients undergoing general anesthesia. In this case a physician's order is not needed. This use and need for an order is specific to the care processes, patient need and organization mission.
References:
- The FDA confirmation was provided by James E. Dillard III, Director, Division of Cardiovascular and Respiratory Devices, Office of Device Evaluation, Center for Devices and Radiological Health, Food and Drug Administration."
- American Association for Respiratory Care--Clinical Practice Guidelines, Dallas, TX