Increasing oxygen prescribing during the COVID-19 pandemic

Area of Science:

• Healthcare Quality Improvement
• Clinical Practice Guidelines
• Patient Safety

Background:

• Valid oxygen prescriptions for hospital inpatients remain a challenge, despite numerous quality improvement projects (QIPs).
• British Thoracic Society guidelines recommend setting oxygen target saturation on admission to mitigate undertreatment and overtreatment risks.
• The COVID-19 pandemic highlighted the need to rethink hospital oxygen prescribing guidelines due to non-standard targets and scarcity.

Purpose of the Study:

• To propose and evaluate three novel, remote interventions to improve compliance with valid oxygen prescribing for hospital inpatients.
• To compare the effectiveness of these novel interventions against previously published successful interventions from BMJ Open Quality.

Main Methods:

• A quality improvement project (QIP) utilizing three plan-do-study-act cycles with novel remote interventions: email to ward pharmacists, email to ward nurses, and WhatsApp to junior doctors.
• A comparative approach using previously successful interventions from BMJ Open Quality on a parallel ward.
• The main outcome measure was the proportion of patients with a valid oxygen prescription.

Main Results:

• The novel interventions achieved a compliance rate of 70% from a 0% baseline.
• Previously published interventions achieved 55.6% compliance from a 17.9% baseline.
• The novel, adapted interventions demonstrated superiority in increasing valid oxygen prescriptions compared to prior methods.

Conclusions:

• Novel, remote, and adapted interventions targeting multidisciplinary teams are superior to previously described methods for improving inpatient oxygen prescribing.
• These interventions are effective even within the context of social distancing.
• Successful implementation of these QIPs can significantly enhance patient safety regarding oxygen therapy.