A new oxygen prescription produces real improvements in therapeutic oxygen use

In the UK, safe use and administration of oxygen therapy was unsatisfactory prior to the implementation of national guidelines in 2008. Each year since then the British Thoracic Society (BTS) has conducted a national audit that has demonstrated a slow but steady improvement in oxygen use across four key standards. Sandwell and West Birmingham NHS Hospitals Trust has participated in this audit process but has failed to show consistent improvements. The aim of this quality improvement project was to produce meaningful and sustained improvements in oxygen use across each of the four standards. Four interventions were developed over three PDSA cycles and included: 1. a new oxygen prescription chart, 2. oxygen 'alert' stickers for use on drug and MEWS charts, 3. point of care resources, and 4. senior led educational sessions for healthcare staff. Each intervention was tested on the Acute Medical Unit over seven days and data collected using the BTS data collection form. The QIP improved oxygen use across each of the standards: baseline measurement for standard one demonstrated that 55% of patients using oxygen had a valid oxygen prescription, improving to 94% after PDSA cycle three. For standard two, baseline measurement demonstrated that 50% of patients had a documented oxygen target saturation range, improving to 94% after PDSA cycle three. For standard three, baseline measurement demonstrated that 84% patients using oxygen had saturations documented on the MEWS chart, improving to 100% after PDSA cycle three. Finally, baseline measurement of standard four demonstrated that 0% patients with a valid oxygen prescription had it signed for at drugs rounds, improving to 18% after PDSA cycle three. Oxygen use was substantially improved during the QIP. Following engagement with stakeholders a new oxygen prescription will be rolled out within the Trust with projected annual savings of £30,400.