Improving oxygen prescribing rates by tailoring interventions for specific healthcare professional groups

Oxygen prescription remains a nationwide problem. The dangers associated with unregulated oxygen administration are well described in the literature with the potential for serious harm in patients with chronic hypercapnia, as well as potentially delaying discharge in patients who are administered it without a prescription. This project identifies poor compliance with regional and national standards and sets out to improve the frequency of oxygen prescribing on a cardiology ward. By studying the problem at a Somerset district general hospital we identified two main groups of professionals responsible for the poor compliance, nursing staff (who administer the oxygen) and junior doctors (who should prescribe it). A series of interventions was designed to firstly raise awareness of the problem within these two groups before going on to target each group with a further intervention over 24 weeks. At baseline we found only 11.3% of patients receiving oxygen had it prescribed. At the end of the project this had improved to 69.6%. We also found that following raised awareness in the nursing staff and introduction of a bedside warning the number of patients receiving oxygen on the ward fell by 35%. In conclusion, this project outlines a strategy for improving oxygen prescribing rates on a medical ward. By targeting different populations we had hoped to see a cumulative improvement after each improvement cycle, however, some resistance from junior doctors in engaging with our third intervention was reflected with a slight decrease in prescribing rates. Further work should address this issue and look to apply this strategy across a wider clinical area with a greater sample size to see if the results are replicable on a larger scale.