An audit of oxygen supplementation in a large tertiary hospital – we should treat oxygen as any other drug

Devoe, N.C.; Kyriazis, Periklis; Eltanbedawi, Ahmed; Contractor, Anisha; Esposito, Anthony L.; Khan, Muhammad; Daniel, Joseph N.; Stefan, Mihaela

doi:10.1080/21548331.2020.1845018

Cited by 6 publications

(10 citation statements)

References 8 publications

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“…55 208 patients were audited in 180 hospitals and 14.0% were using oxygen which was much higher than the present Salford level of oxygen use (6.0%). An audit at a large American tertiary hospital in 2021 found that 19% of patients were using supplemental oxygen which is more than three times the level of use in Salford 11. The proportion of Salford patients using oxygen at the time of BTS oxygen audits was 18% in 2010, 11% in 2011, 10% in 2012 and 9% in 2015 with a further fall to 6% in the present audit.…”

Section: Discussionmentioning

confidence: 51%

“…An audit at a large American tertiary hospital in 2021 found that 19% of patients were using supplemental oxygen which is more than three times the level of use in Salford. 11 The proportion of Salford patients using oxygen at the time of BTS oxygen audits was 18% in 2010, 11% in 2011, 10% in 2012 and 9% in 2015 with a further fall to 6% in the present audit. Salford has always been a low outlier in BTS audits because of strong local oxygen prescribing policies but there may have been similar downward drift in other UK hospitals since 2015 in the light of the COVID-19 pandemic when lower oxygen thresholds were set for UK hospitals (92–96% instead of 94–98%) and in light of the Chu and Siemieniuk papers in 2018 which cautioned strongly regarding the dangers of hyperoxaemia with a recommendation not to increase the SpO 2 above 96% with supplemental oxygen.…”

Section: Discussionmentioning

confidence: 53%

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Automated audit of hospital oxygen use devised during the COVID-19 pandemic

O'Driscoll,

Bakerly

2023

BMJ Open Resp Res

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BackgroundThe British Thoracic Society (BTS) has organised intermittent audits of hospital oxygen use in UK hospitals since 2008. Manual audits are time-consuming and subject to human errors. Oxygen prescribing and bedside observations including National Early Warning Scores (NEWS2 scores) are undertaken within an integrated electronic medical record (EMR) at this hospital.MethodsThe hospital’s Business Information team were commissioned in late 2019 to devise a bespoke automated audit of oxygen prescribing and use. A summary report displays the oxygen saturation alongside the oxygen prescription status of every patient in the hospital except for critical care units which do not use NEWS2. The display has a ‘traffic-light’ colour scheme (green within target range, amber or red if below range or if above range on supplemental oxygen), with a graph showing oxygen use and saturation levels for patients with each prescribed target range. Clinicians can access raw data including oxygen saturation, oxygen device and flow rate for each individual patient.ResultsOver 51 audits involving 34 352 sets of observations, an average of 6.0% involved use of oxygen and 88.6% of these had a valid oxygen prescription. During the first wave of the COVID-19 pandemic in spring 2020, the monthly percentage of observations involving oxygen use increased to a peak of 10.4% followed by a rise to 10.6% during the second wave and 7.4% during the third (Omicron) wave. Oxygen use returned to baseline after each wave.ConclusionsIn hospitals with integrated EMRs, it is possible to automate all fundamental aspects of the BTS oxygen audits and to monitor oxygen use at individual patient level and a hospital-wide level. This could be particularly valuable during major events such as the COVID-19 pandemic. This methodology could be extended to other clinical audits where the audit questions relate to routinely collected EMR data.

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Section: Discussionmentioning

confidence: 51%

Section: Discussionmentioning

confidence: 53%

Automated audit of hospital oxygen use devised during the COVID-19 pandemic

O'Driscoll,

Bakerly

2023

BMJ Open Resp Res

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“…A "side effect" identified across settings by several observational studies, showing a severe tendency of hyperoxygenation in patients hospitalized with AECOPD, increasing their risk of hypercapnic respiratory failure. [46][47][48][49] The association between the fraction of time with hypoxemia or hyperoxemia and specific items on the MDP in patients admitted with AECOPD needs to be investigated further.…”

Section: Discussionmentioning

confidence: 99%

Automated Oxygen Administration Alleviates Dyspnea in Patients Admitted with Acute Exacerbation of COPD: A Randomized Controlled Trial

Bech¹,

Hansen²,

Ringbæk³

et al. 2023

COPD

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Objective Devices for Automated Oxygen Administration (AOA) have been developed to optimize the therapeutic benefit of oxygen supplementation. We aimed to investigate the effect of AOA on multidimensional aspects of dyspnea and as-needed consumption of opioids and benzodiazepines, as opposed to conventional oxygen therapy, in hospitalized patients with Acute Exacerbation of COPD (AECOPD). Method and Patients A multicenter randomized controlled trial across five respiratory wards in the Capital Region of Denmark. Patients admitted with AECOPD (n=157) were allocated 1:1 to either AOA (O2matic Ltd), a closed loop device automatically delivering oxygen according to the patient’s peripheral oxygen saturation (SpO 2 ), or conventional nurse-administered oxygen therapy. Oxygen flows and SpO 2 levels were measured by the O2matic device in both groups, while dyspnea, anxiety, depression, and COPD symptoms were accessed by Patient Reported Outcomes. Results Of the 157 randomized patients, 127 had complete data for the intervention. The AOA reduced patients’ perception of overall unpleasantness significantly on the Multidimensional Dyspnea Profile (MDP) with a difference in medians of −3 ( p =0.003) between the intervention group (n=64) and the control group (n=63). The AOA also provided a significant between group difference in all single items within the sensory domain of the MDP (all p -values≤0.05) as well as in the Visual Analogue Scale – Dyspnea (VAS-D) within the past three days ( p =0.013). All between group differences exceeded the Minimal Clinical Important Difference of the MDP and VAS-D, respectively. AOA did not seem to have an impact on the emotional response domain of the MDP, the COPD Assessment Test, the Hospital Anxiety and Depression Scale, or use of as-needed opioids and/or benzodiazepines (all p -values>0.05). Conclusion AOA reduces both breathing discomfort and physical perception of dyspnea in patients admitted with AECOPD but did not seem to impact the emotional status or other COPD symptoms.

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“…Supplemental oxygen is among the most administered medical therapies in hospitalized patients [4]. In many hospitals, supplemental oxygen can be administered and titrated without a physician order, in contrast to most medications [5]. New hypoxemia is a cardinal bedside sign of acute or impending decompensation as well as a marker of disease severity for several chronic comorbidities [3].…”

Section: Introductionmentioning

confidence: 99%

“…This is particularly true for those patients who are at risk of type II respiratory failure in whom the risk of hypercapnia is well established. In recent times, several international bodies have advocated for the prescription of oxygen therapy in an attempt to reduce this risk in vulnerable patient groups [5]. Despite this guidance, published data have demonstrated that there has been poor uptake of these recommendations.…”

Section: Introductionmentioning

confidence: 99%

Knowledge, Attitude and Practice and Associated Factors on Oxygen Therapy Among Nurses and Midwives in Y12 HMC-2022 Gc

Kassaw,

Berhe,

Tarekegn

et al. 2024

JBRR

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Background: Oxygen is an essential medical therapy which saves a lot of lives. It is administered as a corrective treatment for conditions resulting in hypoxia (low level of oxygen in the blood). So, the nurse should have more skills and experience to performing this procedure in the aim to maintain the patient's life safe and avoid complications associated with incorrect oxygen administration technique. Objective: The study was conducted to assess the level of knowledge, attitude and practice towards oxygen therapy administration and associated factors among nurses and midwives at Yekatit 12 Hospital Medical college in 2022. Method: To achieve the research objectives a hospital based cross-sectional study was applied. The sample size drawn was 198. Pertinent data for the study were gathered through structured questionnaires. Descriptive and multiple logistic regression were used in the analysis of independent and outcome variables. Result: Data is collected from 211 participants and my response rate is (198)93.8%. Among 198 nurse and midwives 50.5% were males, 49.5% with the range of 30-39yrs and most of them (48.5%) have work experience of 6-9yrs.The mean score of knowledge, attitude and practice were 5.7(SD=1.608),4.01(SD=1.837) and 14.5(3.49) respectively. It is found that the level of knowledge was adequate in 117(59.1%) and poor 81 (40.9%) of participants. Practical skill is found to poor in 63.1% of participants and factors associated with this were absences of oxygen therapy guide line, not participating in any training about oxygen therapy and supply of oxygen delivery system with P-value of 0.01, 0.02 and 0.002 respectively. work experience also contributes for poor practice. Conclusion: There is a clear practical gap among nurses and midwives working in Y12HMC and this study also shows as there is poor attitude in almost have of the participants which high compared to another research. The possible associated factors for poor practice were identified as work experience less than 1yr and absence of training and oxygen guideline. So, to enhance safe use of oxygen therapy the referral hospital needs to push its effort for improving the practice and attitude of nurses and midwives towards oxygen therapy by facilitating trainings, increases the availability of guideline and supply of oxygen.

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An audit of oxygen supplementation in a large tertiary hospital – we should treat oxygen as any other drug

Cited by 6 publications

References 8 publications

Automated audit of hospital oxygen use devised during the COVID-19 pandemic

Automated audit of hospital oxygen use devised during the COVID-19 pandemic

Automated Oxygen Administration Alleviates Dyspnea in Patients Admitted with Acute Exacerbation of COPD: A Randomized Controlled Trial

Knowledge, Attitude and Practice and Associated Factors on Oxygen Therapy Among Nurses and Midwives in Y12 HMC-2022 Gc

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