Introduction Oxygen is one of the most commonly used drugs, but one of the most poorly prescribed. National BTS audits show many patients receive oxygen without prescription1. Local historical data showed over 50% of patients were on oxygen without prescription and not titrated appropriately. Currently there are no targeted interventions to improve practice. We aimed to improve oxygen prescribing and monitoring through simple interventions.
Methods For 5 weeks all patients on oxygen were audited using the BTS audit template. Prescriptions, written orders, target ranges and saturations were recorded, together with the ward and speciality. Nurses were also surveyed to gauge understanding of oxygen management. Subsequently, the key findings were emailed to clinical staff as a Clinical Governance issue and the results were presented to junior doctors, together with targeted teaching on oxygen prescribing. Oxygen “hangers” raising awareness of oxygen management were trialled on 5 medical wards, which were subsequently re-audited.
Results 43% of patients on oxygen had a prescription with target range. A further 13% had a written order in the notes. Medical wards out-performed surgical wards (52% vs. 24%). Oxygen prescriptions were signed by nurses on just 5% of drug rounds. 45% of patients’ saturations were out of range, with 61% of patients with saturations above the 88 92% target range. However, all surveyed nurses reported feeling confident titrating oxygen. Furthermore, 72% and 20% of nurses thought shortness of breath and anxiety were indications for oxygen respectively.
Post-interventions, oxygen prescriptions increased by 35% and there was an increase in nurses signing prescriptions from 7% to 46%. 13% fewer patients’ saturations were out of range.
Conclusions This audit confirms the results of BTS national audit 20121 and NPSA rapid response report2that oxygen is poorly administered in NHS hospitals, putting patients, particularly those liable to CO2 retention, at risk. We found that simple interventions raising awareness can have an impact and improve patient safety, although there is clearly room for further improvement, through further training for both clinicians and nurses.
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