Implementation of a multicomponent intervention to optimise patient safety through improved oxygen prescription in a rural hospital

Abstract

A multicomponent intervention can achieve a significantly increased rate of satisfactory oxygen prescriptions specifying target saturation, including in those who are at risk of hypercapnic respiratory failure.

Acute oxygen therapy: a review of prescribing and delivery practices

“…In the 6 years between 2009 and 2015, 12 papers which measured the accurate or appropriate prescription of oxygen therapy have been reported. 34 , 36 – 40 , 45 , 48 , 52 , 59 – 61 Some of these papers also discussed various interventions that have been tested to improve prescription practices.…”

“…Various reasons have been proposed for this, including: insufficient training and education for medical and nursing staff; 33 , 39 , 41 , 42 , 47 , 51 , 54 , 62 a lack of familiarity with oxygen delivery devices; 51 a lack of understanding of the effects, role and dangers of oxygen therapy; 35 – 37 , 46 , 61 staff time constraints; 48 necessity to maintain SpO 2 >94% due to the “between the flags” track and trigger observations charts; 36 practical issues related to space and place for prescribing oxygen; 35 , 39 , 61 difficulties with changing long established behavior; 36 , 60 patients transferred from other wards/departments with oxygen therapy already in situ; 44 lack of enthusiasm by senior clinical staff; 44 communication difficulties between doctors and nurses; 36 lack of full time staff or staff turnover. 36 , 38 , 48 , 60 …”

“…necessity to maintain SpO 2 >94% due to the “between the flags” track and trigger observations charts; 36 …”

“…Interventions that have been employed are presented in Table 1 and the degree of change achieved pre- and postintervention is presented graphically in Figure 2 . These interventions include: introduction of oxygen alert stickers; 39 , 59 – 61 dedicated oxygen order chart; 35 clearly delineated section on the drug chart or changes to the drug chart to include space for the transcription of oxygen orders; 34 – 36 , 48 , 60 informational posters; 59 – 61 email notification/dissemination of information; 60 , 61 educational session across various clinical specialties and at various key times; 34 , 36 , 39 , 44 , 48 , 56 , 59 – 61 nurse facilitated reminder system; 38 development of hospital guidelines/policy to guide practice; 36 , 42 , 59 , 60 admission bundle with electronic prescribing system; 45 message alerts on computer login screens. 60 …”

“…clearly delineated section on the drug chart or changes to the drug chart to include space for the transcription of oxygen orders; 34 – 36 , 48 , 60…”