RT Journal Article
SR Electronic
T1 Emergency oxygen use and monitoring in the pre-hospital and acute hospital setting - The significance of a common problem
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 4297
VO 40
IS Suppl 56
A1 Jamie Johnstone
A1 Lucy Malpas
A1 Fenella Johnstone
A1 Mike Malpas
YR 2012
UL http://erj.ersjournals.com/content/40/Suppl_56/4297.abstract
AB IntroductionEvidence shows that oxygen (O2) can cause decompensated type 2 respiratory failure (T2RF) increasing morbidity and mortality in COPD patients.AimTo review pre-hospital and emergency hospital use of O2 in COPD patients.MethodsAll COPD admissions in January 2011 to Worcester Royal Hospital were audited against BTS guidelines.ResultsAmbulance documentation showed no record of previous NIV or O2 alert card. There is no box to record FiO2 on the ambulance data form. O2 dose (51.6%) and mask (48.4%) recordings were suboptimal. 60% of patients were given 28% venturi masks and 13.3% non-rebreathe masks. 45.8% of patients were given O2 with adequate saturations (sats). 72% of patients given O2 had sats > 92%.In hospital, 9.5% of clerkings contained a history of prior NIV. 2/3 of patients with adequate sats were given O2. 80% of those on O2 had sats above 92. 36.7% of patients had O2 prescribed with 45% having correct sats ranges. 15 patients had T2RF; 5 with sats > 92%. 3 patients met the criteria of NIV; all had sats > 92%. Mean length of stay (LOS) was 6 days longer in those who had NIV. 90.5% of discharge letters did not contain an ABG result.ConclusionsThere is still a major issue with O2 use and monitoring in COPD patients. Patients are being given too much O2, it is not prescribed and not being documented accurately. This causes increased morbidity and cost, evidenced by those with hyperoxia developing T2RF and longer LOS. We recommend the ambulance data form includes an FiO2 box, O2 prescription is mandatory, documentation is improved and discharge letters include an ABG. Doctors, nurses and paramedics should all be regularly educated in O2 therapy.