Adoption of paediatric and neonatal pulse oximetry by 12 hospitals in Nigeria: a mixed-methods realist evaluation

Abstract

IntroductionPulse oximetry is a life-saving tool for identifying children with hypoxaemia and guiding oxygen therapy. This study aimed to evaluate the adoption of oximetry practices in 12 Nigerian hospitals and identify strategies to improve adoption.MethodsWe conducted a mixed-methods realist evaluation to understand how oximetry was adopted in 12 Nigerian hospitals and why it varied in different contexts. We collected quantitative data on oximetry use (from case notes) and user knowledge (pretraining/post-training tests). We collected qualitative data via focus groups with project nurses (n=12) and interviews with hospital staff (n=11). We used the quantitative data to describe the uptake of oximetry practices. We used mixed methods to explain how hospitals adopted oximetry and why it varied between contexts.ResultsBetween January 2014 and April 2017, 38 525 children (38% aged ≤28 days) were admitted to participating hospitals (23 401 pretraining; 15 124 post-training). Prior to our intervention, 3.3% of children and 2.5% of neonates had oximetry documented on admission. In the 18 months of intervention period, all hospitals improved oximetry practices, typically achieving oximetry coverage on >50% of admitted children after 2–3 months and >90% after 6–12 months. However, oximetry adoption varied in different contexts. We identified key mechanisms that influenced oximetry adoption in particular contexts.ConclusionPulse oximetry is a simple, life-saving clinical practice, but introducing it into routine clinical practice is challenging. By exploring how oximetry was adopted in different contexts, we identified strategies to enhance institutional adoption of oximetry, which will be relevant for scale-up of oximetry in hospitals globally.Trial registration numberACTRN12617000341325.

Performance of a novel reusable pediatric pulse oximeter probe

“…Available estimates suggests it remains low, ranging from less than 30% to more than 70% across different LMIC settings . There are examples of pulse oximeter implementation being feasible in LMIC settings, including Malawi and Nigeria, and resulting in improved referral decision‐making . Barriers to wider implementation include cost, lack of training and supervision, and lack of robust pulse oximeters and probes.…”

Solar-powered oxygen delivery for the treatment of children with hypoxemia: protocol for a cluster-randomized stepped-wedge controlled trial in Uganda

“…In another report from Uganda, most nurses were comfortable with the use of oxygen concentrators but were not familiar with pulse oximetry [6]. To address this gap, recognizing context-specific challenges of implementing pulse oximetry [38], SPO 2 study will train nursing staff in pulse oximetry and safe delivery of O 2 . With enhanced knowledge, skills, and availability of equipment (pulse oximeters and SPO 2 equipment), our study will improve the quality of care provided to hypoxemic patients during the study and after the study has ended.…”

Using intermittent pulse oximetry to guide neonatal oxygen therapy in a low-resource context

“…We did not provide additional refresher training or reminders, as we intended to evaluate routine care. Staff had previously received training and supportive supervision on pulse oximetry and the oxygen protocol in November 2015 16 17. The oxygen protocol recommended using pulse oximetry for every neonate admitted to the nursery, and commencement of oxygen therapy if any SpO 2 reading was <90%.…”

“…The oxygen protocol recommended using pulse oximetry for every neonate admitted to the nursery, and commencement of oxygen therapy if any SpO 2 reading was <90%. Pulse oximeter probes were attached to neonates’ hands or feet and nurses recorded the SpO 2 reading in the patient’s clinical observation chart after an adequate plethysmographic waveform was observed and the SpO 2 reading was stable (typically within 1–2 min) 16. The protocol recommended checking the SpO 2 on admission, within 15 min of any change in oxygen flow rate, and at least once per shift (3 times per day), or more frequently for neonates with severe respiratory distress or signs of deterioration.…”

“…Despite improvements in recent years, oxygen practices in many LMICs remain poor and pulse oximetry is rarely used to guide therapy. Hospital surveys consistently report very low availability of pulse oximeters for paediatric and neonatal use (typically <10%) and low staff awareness of how pulse oximetry should be used in children and newborns 12–16…”