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Oxygen Champions Meeting 3rd December 2008

Oxygen Champions Meeting 3rd December 2008. 11.30-11.35       Welcome and Objectives Ronan O’Driscoll and Tony Davison 11.35-11.45       What has been achieved to date? Tony Davison. 11.45-12.00       Provisional results of baseline oxygen audit (Sept 2008) Ronan O’Driscoll.

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Oxygen Champions Meeting 3rd December 2008

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  1. Oxygen Champions Meeting 3rd December2008 • 11.30-11.35       Welcome and Objectives Ronan O’Driscoll and Tony Davison • 11.35-11.45       What has been achieved to date? Tony Davison. • 11.45-12.00       Provisional results of baseline oxygen audit (Sept 2008) Ronan O’Driscoll. • 12.00-12.10       Next stepsTony Davison. (What needs to be done now at each Trust and how to do it) • 12.10-12.30       Open discussion

  2. British Thoracic Society Guideline for emergency oxygen use in adult patients Endorsed by: Association of Respiratory Nurse Specialists Association for Respiratory Technology and Physiology British Association for Emergency Medicine British Cardiovascular Society British Geriatric Society British Paramedic Association Chartered Society of Physiotherapy General Practice Airways Group (GPIAG) Intensive Care Society Joint Royal Colleges Ambulance Liaison Committee Resuscitation Council (UK) Royal College of Anaesthetists Royal College of General Practitioners Royal College of Midwives Royal College of Nursing Royal College of Obstetricians and Gynaecologists (approved) Royal College of Physicians (London, Glasgow, Edinburgh) Royal Pharmaceutical Society of Great Britain Society for Acute Medicine O’Driscoll BR. Howard LS, Davison AG. Thorax 2008; 63 Suppl VI

  3. Audit of oxygen use in UK hospitals July-September 2008 –Provisonal Results(Before Guideline Launch in October 2008) • Oxygen champions conducted audits • Methodology- BTS Audit tool • Data submitted online • 118 data sets submitted • 19 not analysed due to missing Trust name, duplicate Trust name or missing key data • Data sets from 99 Trusts were analysed

  4. Use of oxygen in 99 UK Hospital Trusts • 14,830 patients audited on 712 wards • Mean 150 patients on 7 wards at each Trust • 2,597 patients were using oxygen (17.5%)

  5. 712 wards audited • 26% General Medical • 20% General Surgery • 20% Respiratory Medicine • 11% MAU • 10% Elderly Care • 13% other • Overall 68% Medical type specialties

  6. Prescription of oxygen • 32% of patients who were using oxygen had some sort of written order for oxygen use • 10% had a prescription or order with a target saturation range • Only 5 of 99 Trusts had a target range specified for > 50% of patients who were using oxygen. Two of these audits were confined to respiratory units with less than 10 patients using oxygen (i.e. 3% of units had effectively implemented a target-based system prior to the Guideline publication)

  7. Modes of oxygen delivery 1 • 38% Continuous oxygen • 8% “PRN” Oxygen • 54% not stated or not clear

  8. Modes of oxygen delivery 2 • 54% Nasal Cannulae • 19% Venturi Mask (mostly 24-28% Venturi) • 8% Simple Face Mask • 7% Humidified oxygen sysems • 4% Reservoir Mask (“Non-Rebreather”) • 2% NIV Systems • 1% Tracheostomy Masks

  9. Modes of oxygen delivery 3 • 3% of patients were on PRN oxygen but coded as on air at the time of audit (AX) • 1% of patients were coded as weaning off oxygen (AW)

  10. Drug rounds & Observation Rounds • 5% of drug rounds for patients on oxygen had a signature for oxygen on the drug card • 94% of scheduled observation rounds were documented to have taken place • Only 47% of patients were using the device and flow rate documented in the bedside documents

  11. 812 Observations Rounds for patients on O2 with a Target Range • 78% of patients within the target range • 15% above the target range • 7% below the target range • If above target range, 10% had FIO2 reduced • If below target range, 9% had FIO2 increased

  12. Conclusions 1 • This was a baseline audit, prior to the launch of the BTS Guideline • About 17% of patients in UK hospitals were receiving oxygen at the time of the audit • This was usually not prescribed and was usually different to what was documented at the bedside • For the minority with a target range, 77% were within the target range but, for the 15% above and the 7% below target, no action was taken in most cases

  13. Conclusions 2 • This was a baseline audit, the Oxygen Champions will change the use of oxygen in UK hospitals in line with the Guideline • The audit will be repeated in 2009 (and at intervals thereafter) and it is hoped that there will be improvements due to the introduction of the Guideline

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