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Item Implementation of intermittent pulse oximetry in low-risk hospitalized bronchiolitis patients(Montana State University - Bozeman, College of Nursing, 2024) Donovan, Alaina Jean; Chairperson, Graduate Committee: Margaret Hammersla; This is a manuscript style paper that includes co-authored chapters.Background: In 2014, the American Academy of Pediatrics (AAP) updated its guidelines, which recommend the utilization of intermittent pulse oximetry (IPOx) in low-risk and non-hypoxemic bronchiolitis patients. IPOx is the utilization of pulse oximetry monitoring intermittently at specified times. The overuse of pulse oximetry has been associated with an increase of hospital length of stay (LOS), alarm burden for RNs, and parental anxiety. Methods: A two-month QI project was implemented in a large Montana hospital's 10-bed inpatient pediatric unit. The project consisted of implementing an Inpatient Bronchiolitis Pathway utilizing IPOx. When criteria were met, IPOx orders were to be placed into the EMR. After each shift, RNs were asked to self-rate their adherence to the IPOx orders. At the end of each month, RNs completed a Likert-style questionnaire that assessed their satisfaction with the pathway and alarm fatigue. Results: During the QI project there were 12 bronchiolitis patients; of those, only eight patients met the necessary criteria. Six out of the eight had IPOx orders placed into the EMR. There was a 75% rate of IPOx order placement for the short and long-term goals. Adherence to the IPOx orders had a success rate of 73% during the month of January and a 57% adherence rate during the month of February. A comparison of mean LOS showed a mean difference of -5.9 hours in January and February of 2024 compared to 2023. The RN questionnaires showed overall satisfaction with the Inpatient Bronchiolitis Pathway and a reduction of alarm fatigue. Conclusion: The implementation of IPOx for inpatient bronchiolitis patients has been shown to decrease hospital LOS, unnecessary interventions, parental anxiety, and alarm fatigue. While the QI project does show possible improvement to LOS, a study with a longer time frame and increased sample size is needed to determine any clinical significance. The questionnaire suggests decreased alarm fatigue with the implementation of IPOx, which shows that even a small change could significantly impact RN alarm burden. Well-defined guidelines and education to staff and parents should be prioritized to continue to improve adherence to IPOx in the bronchiolitis population.