Improving Safe Oxygen Therapy Through Education: A Quality Improvement Project

Oxygen therapy is a commonly used intervention in the emergency department (ED) and can be lifesaving when appropriately indicated. However, inappropriate administration, inadequate reassessment, and delayed weaning may result in unnecessary oxygen exposure and potential harm. This quality improvement project aimed to improve nurses' knowledge and awareness of safe oxygen therapy practices through targeted education and a structured oxygen review prompt incorporated into routine clinical handover.

A two-cycle Plan-Do-Study-Act (PDSA) methodology was undertaken in the ED of a tertiary care hospital in India. Thirty ED nurses participated voluntarily and completed a structured 10-item questionnaire assessing knowledge and awareness of safe oxygen therapy, including oxygen as a medication, target oxygen saturation ranges, monitoring, potential harms of excessive oxygen administration, and oxygen review, reassessment, and weaning principles. The first PDSA cycle consisted of alternate-day educational sessions delivered over two weeks. The second cycle incorporated a structured oxygen review prompt into routine nursing and medical handovers for a further two weeks.

At baseline, 18/30 nurses (60%) achieved satisfactory questionnaire performance. This increased to 22/30 (73.3%) following PDSA cycle 1 and to 28/30 (93.3%) following PDSA cycle 2. The observed increase represented an improvement in overall questionnaire-based knowledge and awareness across the three assessment stages. However, actual bedside oxygen prescribing, reassessment, and weaning practices were not directly observed or audited.

The project identified important gaps in nurses' knowledge of target oxygen saturation ranges and highlighted the importance of reinforcing safe oxygen review and reassessment. Sequential implementation of targeted education and a structured oxygen review prompt incorporated into routine clinical handover was associated with improved questionnaire performance among participating ED nurses. Embedding safe oxygen principles and oxygen reassessment into existing clinical workflows may provide a practical approach to supporting staff knowledge and promoting safer, more individualized oxygen therapy in the ED. Further evaluation using objective clinical measures and longer-term follow-up is needed to determine whether improvements in questionnaire performance translate into sustained changes in actual oxygen therapy practice.