Learning from Mistake

On my current rural and remote prac, I was treating a 78 year old man who came in with sore (L) foot secondary to gout with an extensive history of cardiac diseases. At rest, his heart beat was irregular 40-77bpm and oxygen saturation was 97% on room air. During ambulation, his oxygen saturation dropped to 79% on room air post-60 metres, and recovers to 94% in 2 minutes. I then raised this problem to the patient’s consultant during a team meeting. The consultant initially stated that the problem might have been caused by the oximeter but I insisted that I had checked both his hands temperature and swapped between pt’s fingers/hands to confirm the finding. The consultant then decided to have a chest x-ray done on the pt and asked me to re-assess the patient again, and if his O2 sats continues to drop to 80% on RA, they will perform an ABGs test. I consulted my supervisor regarding this patient and my supervisor was willing to see this pt with me. On re-assessment, the same thing happened again and my supervisor explained that it was normally perfusion problem when O2 sats dropped below 80% and I should try using ear probe instead of finger probe. We had to go to the paeds ward to borrow an ear probe oximeter and on reassessment, the patient’s oxygen sats turned out to be fine, maintaining 94% on RA throughout ambulation. On reflection, I should have thought of this problem and tried using ear probe in the first place. I should have checked all possible causes that can lead to dropping of O2 sats and not to forget the use of other equipments even though they are often not provided in the ward in order to justify & confirm my assessment findings before discussing with the consultant or other health professionals to avoid confusion.