Oxygen Stewardship in Adult Critical Care: A Quality Improvement Initiative

Area of Science:

• Critical Care Medicine
• Quality Improvement Science
• Nursing Practice

Background:

• Oxygen therapy is prevalent in critical care but often administered above recommended targets.
• Excessive oxygen use can lead to patient harm and increased healthcare costs.
• Current adherence to oxygen titration guidelines in intensive care units is inconsistent.

Purpose of the Study:

• To assess the effectiveness of a nurse-engaged oxygen stewardship initiative.
• To evaluate impacts on adherence to oxygen saturation targets.
• To measure changes in oxygen consumption within an adult intensive care unit.

Main Methods:

• A 21-month clinician-led, before-and-after quality improvement study.
• Intervention included a standardized oxygen weaning protocol, multidisciplinary education, and audit with feedback.
• Workflow reminders, staff feedback, and iterative refinements were utilized.

Main Results:

• Patient-days outside target oxygen saturation ranges decreased from 63% to 20% post-intervention, with sustained results.
• Significant reductions in median monthly oxygen consumption were observed for conventional, non-invasive, and mechanical ventilation.
• High-flow nasal cannula therapy showed higher non-compliance and no significant reduction in oxygen use.

Conclusions:

• Oxygen stewardship integrated into critical care workflows led to sustained improvements in oxygen titration and reduced consumption.
• Behavioral reinforcement and integration into daily nursing practice were crucial for sustained adherence.
• Structured initiatives empower nurses to deliver guideline-adherent oxygen therapy and reduce unnecessary exposure.