Rationalising oxygen use to improve patient safety and to reduce waste
The IMPRESS step-by-step guide September 2010
The consultation for the Strategy for Services for Chronic Obstructive Pulmonary Disease (COPD) in England contains 24 recommendations for improvements in the delivery of care for people with COPD and asthma. As it comes without additional funding, efficiencies will need to be made to balance the books. How should you get started in the current tough financial climate?
IMPRESS has produced a guide More for Less that recommends that one area of potential waste, and ineffective care that is crying out for change, is in the prescribing and ordering of oxygen. (See extract at Appendix 1). According to the national consultation document over 60% of home oxygen is used by people with COPD.
Here is our step-by-step improvement guide. If you follow these steps we would expect that you will improve care. You will also probably release savings that we hope you would negotiate with your local commissioner could be reinvested in implementing some of the other recommendations in the national strategy. You can start this now.
Note this guide refers to adult patients.
Appendices include:
Appendix 1 - Extract from the IMPRESS guide More For Less setting the context of improving quality and potentially reducing cost with examples of oxygen services from around the country
Appendix 2 - Home Oxygen Order Form information
Appendix 3 - South Essex home oxygen service checklist for nurse team
Appendix 4 - Information for Patients in England and Wales: Arranging, trying and using Short-burst Oxygen Therapy to abort Cluster Headaches
Appendix 4 - Information for GPs and Neurologists: Arranging Short-burst Oxygen Therapy for patients in England and Wales with Cluster Headaches
Appendix 5- example of report from supplier, SHA level, showing variation
Appendix 6 - Oxygen prescribing - information for GPs
Appendix 7 - London Ambulance Service NHS Trust Patient Specific Protocol and Oxygen Alert Cards - Flagging process between Southend University Hospital Trust and East of England Ambulance NHS Trust
To download click here.
January 2011
Latest evidence on safety
The Austin paper published in the BMJ in October (BMJ 2010; 341:c5462) shows that the mortality in acute COPD is more than doubled if high concentration oxygen is given.
Latest evidence on effectiveness
Moore and McDonald paper in Thorax 2011;66:32-37 doi:10.1136/thx.2009.132522 A randomised trial of domiciliary, ambulatory oxygen in patients with COPD and dyspnoea but without resting hypoxaemia concludes that "In breathless patients with COPD who do not have severe resting hypoxaemia, domiciliary ambulatory oxygen confers no benefits in terms of dyspnoea, quality of life or function. Exertional desaturation is not predictive of outcome. Intranasal gas (either air or oxygen) may provide a placebo benefit."
Emergency oxygen service shortlisted for HSJ and Nursing Times Patient Safety Awards 2011, January 2011
A submission from the British Thoracic Society, Salford Royal Foundation Trust and Southend University Hospital Foundation Trust was shortlisted in the patient safety in clinical practice category. The teams estimate that too much oxygen may cause 2000-4000 avoidable deaths a year with COPD. There is probably nothing else that can alter an outcome in COPD as much as giving the correct oxygen.
Download presentation here.
British Thoracic Society Oxygen Champions and Audit
The BTS has set up Oxygen Champions in each acute trust. The BTS did a recent audit and the uptake of the Emergency Oxygen Guideline is increasing quite rapidly. However, there are still areas where the guideline has not been fully instigated. The BTS Emergency Oxygen Audit will continue yearly and is now recommended for inclusion in the quality accounts from 2010-2011. This means that all the hospital results will be published.