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Emergency Oxygen use in UK Hospitals BTS HOSPITAL OXYGEN AUDITS 2008- 2012 Dr Ronan O’Driscoll

Emergency Oxygen use in UK Hospitals BTS HOSPITAL OXYGEN AUDITS 2008- 2012 Dr Ronan O’Driscoll Salford Royal NHS Foundation Trust Salford M6 8HD ronan.o.driscoll@srft.nhs.uk Acknowledgements: Tony Davison, Lisa Ward, Rachel Smith, Norma Linaker,

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Emergency Oxygen use in UK Hospitals BTS HOSPITAL OXYGEN AUDITS 2008- 2012 Dr Ronan O’Driscoll

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  1. Emergency Oxygen use in UK Hospitals BTS HOSPITAL OXYGEN AUDITS 2008- 2012 Dr Ronan O’Driscoll Salford Royal NHS Foundation Trust Salford M6 8HD ronan.o.driscoll@srft.nhs.uk Acknowledgements: Tony Davison, Lisa Ward, Rachel Smith, Norma Linaker, Christine Bucknall, Sally Welham,Chris Routh, Kerry Reid Oxygen Champions and colleagues at 145 hospitals/Trusts

  2. Audit 1 July-Sept 2008Before Guideline launch in October 2008 Audit 2 November 2009Audit 3Oct-November 2010Audit 4Aug-November 2011 BTS Emergency Oxygen Audits • Oxygen champions conducted audits • Methodology- BTS online Audit tool Audit 5 Aug-November 2012

  3. Overview of results 2008-2012 *Definition of “on oxygen” in 2008-09 included patients with a prescription who were not on oxygen at the time of audit

  4. Prescription of oxygen 32% of patients who were using oxygen had some sort of written order for oxygen use in 2008 69% in 2009 (47 Trusts) 56% in 2010 (90 Trusts) 48% in 2011 (156 Trusts) 52% in 2012 (145 Trusts) Possible selection bias in earlier audits (more medical wards)

  5. Prescription of oxygen 20125628 patients on oxygen • 46% prescription with target range* • 6% other written order without target range • 48% on oxygen but no written order 24% range 94-98% 18% range 88-92% 4% other range

  6. Oxygen prescribing 2008-2011

  7. Drug rounds & Observation Rounds

  8. Observations Rounds for 2483 patients on Oxygen with a Target Range 2012 • 57% of patients within the target range • 31% of patients outside the target range 10% not possible to judge due to use of NEWS chart *It is not possible to be more than 2% above target range if the patient’s target range is 94-98%. Therefore, all patients who are more than 2% above target must be at risk of hypercapnic respiratory failure.

  9. Royal College of Physicians NEWS National Early Warning Score

  10. Royal College of Physicians NEWS chart • Not possible to identify actual oxygen saturation if “dots” are used instead of actual numbers being entered. • Not possible to identify oxygen delivery system/flow rate • Not possible for nurse or HCA to calculate “Inspired Oxygen” unless the patient is using a Venturi device

  11. Individual Hospital Feedback All Wards

  12. Individual Hospital Feedback Respiratory Wards

  13. Implementation Audits

  14. Does your hospital have a policy of setting a target range for all patients on admission to hospital to guide oxygen therapy if an emergency occurs? Yes 65 Hospitals (70%) (49% in 2011) No 28 Hospitals (30%)

  15. Electronic Prescribing in 2012 • 11 of 94 responding hospitals (12%) have fully Electronic Prescribing in 2012(8% in 2011) • Partial Electronic Prescribing (8%) (7% in 2011) • Paper Prescribing (80%)

  16. Summary • Things are getting better—but slowly • There are institutional barriers to modernisation of clinical practice • Training of health care professionals is the greatest challenge BTS Oxygen Audits are supported by NAGCAE (National Advisory Group on Clinical Audit and Enquiries) and included in Trust Quality Accounts

  17. Making it happen every time • Use Admission Orders Bundles

  18. Admission Orders Choose from Medicine, Surgery or Critical Care

  19. Medical Admission orders HAT Thromboprophlylaxis MRSA Prevention Oxygen Target Range …..scroll down …see next slide

  20. Medical Admission orders HAT Thromboprophlylaxis MRSA Prevention Oxygen Target Range

  21. Target Saturation 88-92% Note defaulted information.

  22. Target Saturation 94-98% Note defaulted information.

  23. This is what the medication orders chart of an Asthma patient might look like With Target Range 94-98%

  24. This is how you can tell what drugs have actually been given on each drug round. The dots are replaced by nurse initials or “Air” as the nurse undertakes the medication round

  25. This is what the nurse enters if the patient is on air at the time of the drug round

  26. Oxygen prescribing and documentation on drug rounds *Electronic prescribing with “Admissions Order Set” was introduced at SRFT over the course of 2010

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