NOTE May 2014:

The EIGA (European Industrial Gases Association) have updated their recommendation for patients using oxygen therapy.

'Electronic cigarettes should not be used whilst a patient is undergoing oxygen therapy. Additionally, batteries of electronic cigarettes should not be charged in the vicinity of a patient undergoing oxygen therapy or the oxygen source itself.'

EIGA will amend documents* relating to Homecare oxygen to reflect the above advice.

It is well recognised that since oxygen supports combustion, smoking, or being close to an energy source such as an open flame, is incompatible with the use of oxygen. E-cigarettes include a power source, which may be charged from a USB port or a battery charger. If saturated with oxygen these items could ignite. There are recent reports in the media of ignition of an e-cigarette whilst a patient is undergoing oxygen therapy, e.g.:

http://www.manchestereveningnews.co.uk/news/greater-manchester-news/stockport-gran-engulfed-flames-after-6985434

*EIGA Doc 89 Medical Oxygen Systems for Homecare Supply and EIGA Doc 158 Good Homecare Practice

Rationalising oxygen use to improve patient safety and to reduce waste

The IMPRESS step-by-step guide September 2010; revised 2nd edition published May 2011

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.  The provision of oxygen has now been tendered across England (completed mid 2012) but the principles in the step-by-step guide remain valid.

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 this and other IMPRESS documents go here.

DH Commissioning Guide for oxygen
This includes a service specification and costing tool. 

This guide complements the  Home Oxygen Service - Assessment and Review - Good Practice GuideHome Oxygen Service - Assessment and Review - Good Practice Guide issued in May 2011 by NHS Primary Care Commissioning on behalf of the Department of Health, British Lung Foundation, BTS and PCRS-UK and others.   The IMPRESS guide covers adults only - the NHS PCC guide covers children as well as adults. 

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 won for HSJ and Nursing Times Patient Safety Awards 2011, March 2011

A submission from the British Thoracic  Society, Salford Royal Foundation Trust and Southend University Hospital Foundation Trust won 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.

See 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.