Home Oxygen Safety in an Urban Population: A Multipronged Approach

Home oxygen improves the survival of patients with severe chronic hypoxic lung disease, but is associated with an increased risk of burns, fires, and fatalities. There is minimal data about potential risk factors for fires and burns in an urban population discharged from the hospital to the community on oxygen. This is a 7-year retrospective chart review of patients discharged on oxygen to a Certified Home Health Agency. The highest risk patients were defined as those believed by a nurse to be at imminent danger of causing a burn or fire and requiring review by an Emergency Committee; these are analyzed in more detail. A total of 1,301 patients were discharged on home oxygen. Twenty-six patients were identified as highest risk and required emergency interventions. Risk factors for burns and fires included: 85% active smokers, 46% substance use disorder, and 19% unstable psychiatric disease or an unreliable caregiver. The primary care physician in the community was unaware that the patient had oxygen in the home in 35% of these cases. A Home Oxygen Safety Committee was convened to address improvements in the Electronic Health Record, hospital infrastructure, and patient and caregiver education to improve home oxygen safety. Burns and fires related to home oxygen are rare events but can be devastating to the patient, caregivers, and community. Establishing a regulatory requirement that oxygen be included on the medication list at hospital discharge, and in the ambulatory setting, has the potential to improve transitions of care for this vulnerable population.