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NPSA urges safety checks after nine patient deaths

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Nine patient deaths due to poorly-managed oxygen supplies have prompted the National Patient Safety Agency (NPSA) to urge hospitals to check their equipment.

It reports that there were 281 serious incidents between December 2004 and June this year, which may have contributed to a further 35 deaths in England and Wales.

Common incidents included the wrong dose of oxygen being given, concentrations not being properly monitored, oxygen being confused with compressed air, empty cylinders and faulty and missing equipment.

Says NPSA medical director Dr Kevin Cleary: “Oxygen is one of the most common medicines given to thousands of patients each day across England and Wales and most is given safely.

“However, because of a lack of awareness, oxygen is often given without any prescription and patients are attached to oxygen tubing with no documentation of their medicine on their treatment chart.

“Our recommended actions should make systems safer by reducing reliance on cylinders and reminding staff of the need to follow clinical guidelines in safe prescribing, administration and monitoring of patients on oxygen.”

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