Introduction and Objectives National audits show oxygen prescribing is still not consistently safe and appropriate, despite the 2008 BTS Emergency Oxygen Guidelines. The aim of this study was to assess whether medical students taking Final MBBS examinations are able to prescribe oxygen safely and appropriately.
Methods A 2012 medical school Final MBBS Objective Structured Clinical Examination station assessed oxygen prescribing. Candidates were presented with one of two clinical scenarios requiring an oxygen prescription on a drug chart; Scenario 1: 72-year-old patient with COPD, and Scenario 2: 72-year-old hypoxic patient without respiratory disease. Prescriptions from 227 out of 363 students taking MBBS were retrospectively assessed against BTS standards using the criteria; correct target saturation range, oxygen flow, device and frequency of delivery. The remaining prescriptions were not available for analysis. Prescriptions were classified as ‘safe/unsafe’ and ‘perfect (met all standards)/imperfect’ by a respiratory nurse specialist.
Results 66/122 (54%) of candidates wrote the correct saturation range for the COPD scenario, compared with 42/105 (40%) for scenario 2. Oxygen flows were correct in 74/122 (60.6%) of COPD and 4/105 (3.8%) of scenario 2 prescriptions. The flow was appropriate for the device in 91.2% (207/227) and prescriptions specified ‘continuous’ oxygen in 60.8% (138/227). 59/122 (48.4%) prescriptions for COPD were safe and 26/122 (21.3%) ‘perfect’ compared with 19/105 (18.1%) safe and 0/105 (0%) perfect prescriptions for the hypoxic patient without respiratory disease. 185/363 (51%) students passed this station with overall year pass rate for finals 96% (349/363).
Conclusions This study demonstrates an important unmet need in undergraduate education as competence in, and safety of, oxygen prescribing by otherwise successful MBBS candidates was poor. Of the prescriptions available for analysis, only half used appropriate target saturations. Half of prescriptions for COPD scenario were safe but only one in five met all BTS standards. No prescriptions for hypoxia without respiratory disease met all standards and one in five was safe. We believe that this reflects the undergraduate teaching focus on oxygen in COPD. We recommend introducing a compulsory undergraduate e-learning module on oxygen delivery and prescribing as newly-qualified doctors need to be able to prescribe oxygen safely.
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