Debbie Roots Todays Aims When is oxygen prescribed What types of patients For what reason is oxygen prescribed Who prescribes oxygen Who thinks oxygen is freely available to all patients in the home ID: 1010675
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1. Oxygen safety in care homesDebbie Roots
2. Todays AimsWhen is oxygen prescribed?What types of patients?For what reason is oxygen prescribed?Who prescribes oxygen?Who thinks oxygen is freely available to all patients in the home?Do you think oxygen is a drug?When do you use the static cylinder that is supplied with the concentrator?What is the difference between the large static cylinder v standard ambulatory cylinders?Do you have a copy of the prescription?Do you have a management plan for your patient on oxygen therapy?Does this include what to do in an emergency?Who do you call when your patient breathing deteriorates and their oxygen saturation levelsdecreases?Are you aware of this patient’s target saturations?Who do you call to assess your patient?Is it appropriate to turn up the flow rate on a ‘fixed flow rate’ prescription?What are the risk for patients on home oxygen therapy?What is the difference between home oxygen therapy v emergency?
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4. Background Oxygen is a medicine that should always be planned, prescribed and reviewed by staff trained in oxygen prescription and use.Oxygen is a medicine to treat hypoxia, not breathlessness, and therefore should not be prescribed for breathlessness without hypoxia (cluster headache excluded).Why? Connotations and culture:Universal, Everyday, Essential, Unassailable “good”, Vital, Pure, Fresh, Clean..
5. Pulse OximetrySimpleInitial assessmentNon invasiveAll care homes should have one
6. Oxygen treats hypoxia it does not treat breathlessness. If patients have low blood oxygen levels, the long-term use of oxygen at home could be of benefit to them. The only evidence is for it to be used at least 15 hours a day.Ambulatory oxygen therapy must be prescribed by the HOSAR and assessed when the patient is stableRationale for home oxygen7/22/2020
7. Oxygen is a medicine that should always be planned, prescribed and reviewed by staff trained in oxygen prescription and use.Oxygen is a medicine to treat hypoxia, not breathlessness, and therefore should not be prescribed for breathlessness without hypoxia (cluster headache excluded).Why? Connotations and culture:Universal, Everyday, Essential, Unassailable “good”, Vital, Pure, Fresh, Clean..OXYGEN = A MEDICAL GAS = A MEDICINE7/22/2020
8. Just as any other medicine, oxygen should not be prescribed without a clear indication, dose and duration. Intended benefits, risks and contraindications should be considered. Acute oxygen prescription must include the target oxygen saturation range and state the appropriate interface and range of flow rates to achieve this. Oxygen saturations must be monitored according to an agreed and feasible management plan. Those who administer oxygen should have regular and ongoing training so that they are able to monitor and respond to a patient’s oxygen saturations within the management plan.7/22/2020
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15. Long Term Oxygen Therapy Administration of oxygen at concentrations higher than those noted in room air for patients with chronic hypoxia with aim of: Reducing hypoxaemia Improving survival Decreasing ventilatory load Decreasing pH & myocardial load Reducing arrhythmias Reducing secondary polycythaemia Improving sleep quality Reducing disability Improving neuropsychological health 7/22/2020
16. What next?If it is decided that oxygen is clinically appropriate then the assessor will risk assess the patient and discuss the best delivery method for them. A IHORA and consent form must be completedThe assessor then completes a Home Oxygen Order Form(HOOF A) on the oxygen portal.Air Liquide is the supplier of oxygen across London. Air Liquide will deliver the equipment and instruct the patient/carer on how to use itThe patient is reassessed in 4-6 weeks to see how they are managing-if there are issues before then they can contact the ACERS team.
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19. DELIVERYOxygen can be delivered by mask or nasal cannula.Venturi valves should be used which are colour coded to delivery amount.
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27. COMPLICATIONSOxygen can result in a dry mouth, drinking plenty of water is recommended.The nose can become sore. Petroleum gel should not be used but a water based gel can.Pressure sores can develop on the bridge of the nose or the ears, it may be necessary to apply padding to the tubing over these areas.
28. Most breathlessness in cancer patients is caused by specific issues such as airflow obstruction, infections or pleural effusions and the main issue is to treat the causeOxygen has been shown to relieve dyspnoea in hypoxaemic cancer patients but not if PaO2 is >7.3 kPa (saturation above about 90%)Morphine and Midazolam also relieve breathlessness and are probably more effectiveOxygen use in palliative care7/22/2020
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30. Oxygen can benefit some people.Oxygen is a very expensive treatment and therefore should only be used appropriately.A fan is often as effective for breathlessness as oxygen!If you believe a patient needs home oxygen call ACERS for support CONCLUSION
31. Based at Homerton University HospitalPhone :- 0208 510 5107E Mail :- homertoncopd@nhs.netAir Liquide patient line :-0808 143 9991