Clinical Audit of Acute Oxygen Therapy: Enhancing Patient Care at Atbara Teaching Hospital

Acute oxygen therapy is vital for managing critically ill and hypoxemic patients, with British Thoracic Society (BTS) guidelines emphasizing precise prescribing, target saturation ranges, and continuous monitoring. Despite clear protocols, global audits reveal frequent lapses in documentation, prescription clarity, and adherence to saturation targets. The objective of this audit was to evaluate and improve the practice of oxygen therapy delivery in the emergency department at Atbara Teaching Hospital, Atbara, Sudan, through baseline assessment, implementation of a standardized protocol, and targeted educational sessions, with reassessment in a follow-up cycle to measure impact.

A mixed retrospective-prospective audit was conducted over two cycles (Cycle 1: 15^th September to 15^th October, 2024; Cycle 2: 10^th June to 24^th June, 2025). Thirty patient records per cycle were assessed against BTS standards, including correct oxygen delivery modes/flow rates, documentation of saturation, target specification (88% to 92% for type 2 respiratory failure), weaning protocols, and discontinuation practices. Post-baseline gaps interventions included staff education and standardized checklists.

Cycle 1 revealed critical deficiencies, which were as follows: nasal cannula at 2-6 L/min (26.0%; 8/30), non-rebreather mask at 10-15 L/min (17.4%; 5/30), weaning compliance (33.3%; 10/30), and target saturation documentation (46.7%; 14/30). Post intervention (Cycle 2), nasal cannula compliance reached 100% (30/30; +74%), non-rebreather mask 91.6% (27/30; +74.2%), and face mask 100% (30/30; +21.7%). Documentation of oxygen saturation improved to 100% (30/30; +10%), target saturation recording to 100% (30/30; +53.3%), and weaning compliance to 91.6% (27/30; +58.3%). Immediate oxygen for at-risk patients rose to 96.7% (29/30; +16.7%). Notably, timely discontinuation decreased to 76.7% (23/30; -13.3%), and the target range specification for type 2 failure remained suboptimal (66.7%; 20/30).

Education and protocol implementation significantly improved oxygen delivery accuracy and documentation. The decline in discontinuation compliance highlights an ongoing challenge requiring focused interventions. Sustained adherence necessitates regular reinforcement and re-auditing.