Nationwide UK audits by the British Thoracic Society have shown that more than half of UK hospital patients who are using oxygen do not have a prescription for this drug (Thorax. 2011; 66:734). We have audited the prescription and monitoring of oxygen use amongst 347 patients on nine medical wards at our 800 bedded teaching hospital which has a policy of prescribing a target oxygen saturation range for all patients on admission to hospital, using an “admissions bundle” within the electronic prescribing system.
97% of these medical patients had an oxygen saturation range prescribed in the electronic record and a further 1% had a target range specified on bedside documents. 79% of prescriptions were for a target range of 94–98%, 20% were for a range of 88–92% and 1% were for patient-specific target ranges. 10% of medical patients were receiving oxygen at the time of this audit.
92% of all patients were within their specified target range, 3% were above the target range (all of them on oxygen therapy) and 2% were below their target range (all of them breathing air at the time of audit). In 17 of 19 cases where patients were outside their target range, no action was taken by those making the observations. A particular concern in this audit was that 4% of patients had a different target saturation range on the bedside observation chart compared with the prescribed range. This led to some of the above errors.
14% of medical patients had risk factors for type 2 respiratory failure. Of the 26 patients who had blood gases taken on the day of audit, 35% had type 1 respiratory failure and 27% had type 2 failure.
This audit has shown that electronic prescribing systems with an “admissions bundle” can achieve target prescriptions for oxygen for over 95% of medical patients. However there were discrepancies with the bedside charts in 4% of cases, a problem that will be solved when bedside observations become electronic in future. There are also concerns that appropriate action was not taken in many cases where patients were outside the target range.