Implementing target range oxygen in critical care: A quality improvement pilot study
Rosie Heartshorne1, Jenna Cardell1, Ronan O'Driscoll1
1Departments of Critical Care and Respiratory Medicine, Salford Royal NHS Foundation Trust, Northern Care Alliance NHS Group and Health Innovation Manchester, Salford Royal Hospital, Salford, UK.
Background:
Iatrogenic hyperoxaemia is common on critical care units and has been associated with increased mortality. We commenced a quality improvement pilot study to analyse the views and practice of critical care staff regarding oxygen therapy and to change practice to ensure that all patients have a prescribed target oxygen saturation range.
Methods:
A baseline measurement of oxygen target range prescribing was undertaken alongside a survey of staff attitudes. We then commenced a programme of change, widely promoting an agreed oxygen target range prescribing policy. The analyses of target range prescribing and staff survey were repeated four to five months later.
Results:
Thirty-three staff members completed the baseline survey, compared to 29 in the follow-up survey. There was no discernible change in staff attitudes towards oxygen target range prescribing. Fifty-four patients were included in the baseline survey and 124 patients were assessed post implementation of changes. The proportion of patients with an oxygen prescription with a target range improved from 85% to 95% (χ2 = 5.17, p = 0.02) and the proportion of patients with an appropriate prescribed target saturation range increased from 85% to 91% (χ2 = 1.4, p = 0.24). The improvement in target range prescribing was maintained at 96% 12 months later.
Conclusions:
The introduction and promotion of a structured protocol for oxygen prescribing were associated with a sustained increase in the proportion of patients with a prescribed oxygen target range on this unit.
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