Using pulse oximetry to monitor psychiatric patients at risk of suicide.

Patients admitted to the Hunter New England Local Health District Psychiatric Intensive Care Unit (PICU) or Psychiatric Emergency Care Centre (PECC) (from 14 May 2019) in Waratah, NSW will be invited to wear a pulse oximeter on their wrist with a reusable finger sensor. A baseline reading of each participant's pulse and oxygen saturation levels will be taken. Pulse and oxygen saturation levels will be transmitted to a base unit or computer. Alarm parameters will be set according to percentage variation from the participant's baseline measures. If pulse or oxygen saturation fall outside the configured thresholds, an alarm will sound. Standard thresholds are +/-50 bpm and a drop in O2 levels of >10%. Expert medical advice will be sought to refine parameters to ensure staff are alerted to serious events quickly, but false alarms are not overly frequent. Should an alarm be triggered, unit staff will locate the patient and take any necessary action, such as replacing the sensor or, if suicide has been attempted, removing any ligature and resuscitating the patient, for example. The action taken will be recorded in the comments section of the monitoring software following resolution of the event and in a running sheet for the participant. Participants will wear the pulse oximeter for the duration of their stay in the intensive care unit - generally 1 to 3 days - unless they elect not to participate or to continue. The maximum length of observation is unlikely to exceed 1 week. Use of pulse oximetry is in addition to regular observations and other usual practice and will not replace any mandated procedures. With consent, families, guardians and carers, where feasible, will be asked a few brief questions about their perceptions about the device and its use. Unit nursing staff or the peer consultant will seek consent for the intervention[1] attach the device to the patient if consent is given, and will set up and monitor the base station or computer software for alarms. Staff will replace and recharge batteries for the device as required. Staff will remove the device from the patient if the patient withdraws from the study, the device becomes too uncomfortable for the participant to continue to wear, or immediately before the patient is discharged. Staff will continue to carry out regular observations of the patient. Use of pulse oximetry is in addition to regular observations of patients by staff and other practice as usual, and will not replace any mandated procedures, such as NSW Health Policy Directive PD2017_025 ‘Engagement and Observation in Mental Health Inpatient Units’. [1] Patients with diminished capacity to consent will be provided with decision-making support by an independent (non-staff) individual such as a peer support worker or legal advocate to ensure that their consent, if given, is valid and free from perceived coercion.