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Warning patients getting 'harmful' levels of oxygen


Many hospital patients are at risk of receiving harmful levels of oxygen therapy, respiratory specialists have warned in a report on the “state of play” of its provision in NHS hospitals.

The British Thoracic Society noted that one in seven patients in UK hospitals are given oxygen therapy for their condition on any given day.

“It is concerning so many hospital patients are still given this drug without any form of prescription”

Ronan O’Driscoll

But its latest audit found that over four in 10 of these patients – equivalent to 6,000 on an average day – were receiving oxygen with no prescription or other written order.

It was concerned patients might be given too little or too much oxygen if there was no script specifying a safe “target range” of desirable levels in the blood, which staff could monitor against. As a result, the society called on every hospital to prescribe and document all oxygen that was administered.

In addition, the audit also found over half of hospitals did not provide sufficient training in oxygen provision and monitoring for doctors or nurses.

Even when a written prescription for oxygen was provided, the audit revealed 31% of patients were still getting either too little or too much oxygen.

The society noted that it was common to have some readings outside the target range, for example because a patient was anxious, but said health professionals needed to monitor the situation and act when necessary.

It was of special concern that 9% of patients who had been prescribed a low target range, because they had conditions such as chronic obstructive lung disease where too much oxygen was harmful, were more than 2% above it.

However, the review did highlight marked improvements in many aspects of oxygen management and delivery since the launch of the British Thoracic Society Guidelines in 2008.

The society said it was encouraging that 85% of hospitals had implemented an oxygen policy, all used pulse oximeters to measure oxygen levels on every nursing observation rounds and 72% levels in a dedicated oxygen section on a monitoring chart consistent with its guidelines.

Dr Ronan O’Driscoll, consultant respiratory specialist at Salford Royal NHS Foundation Trust, who has led the society’s work on the subject, said: “Oxygen is an important drug and should always be prescribed and documented in hospital like any other medication.

British Thoracic Society

Warning patients getting ‘harmful’ levels of oxygen

Ronan O’Driscoll

“In a modern health service, it is concerning that so many patients in hospital are still being given this drug without any form of prescription,” he said.

He added that it was “concerning” how many patients had oxygen levels that were too high after therapy, which might be down to a feeling among staff that “the more oxygen we give the better”.

However, the audit showed that 44% of patients using oxygen had risk factors such as COPD that meant they were in danger from excessive oxygen therapy.

“This needs to be addressed in staff training and we would like to see far more hospitals delivering education in this area,” said Dr O’Driscoll.

He acknowledged there had been real improvements over the last eight years in how NHS hospitals manage, deliver and monitor oxygen provision for patients, but there had “largely stalled recently”.

The 2015 BTS Emergency Oxygen Audit analysed data from 55,208 NHS hospital patients, of which 7,741 were using oxygen. It took place between 15 August and 1 November 2015.



Readers' comments (5)

  • Oxygen is a medication. All medication must be charted. A phone order must be signed within 24 hrs by the prescribing MO. That is how I've been trained. No script, no oxygen.

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  • Working on a Respiratory ward, we would get quite a few patients coming in to us on a regular basis with COPD, and it is always documented in their plan and the medicine kardex target seats range, and Oxygen % and by which method, ie: Venturi mask, nasal specs, or Humidified O2!!
    Nursing Staff have to sign for it at each medicine round, and it is also on the Ews chart.

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  • Unbelievable! Gasps in amazement!

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  • As I understand it, oxygen is only given without prescription in an emergency!

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  • Flow of oxygen is very haphazard. Nasal tubes can be better for some although uncomfortable for others. More often than not masks have fallen off or are pulled off and are feeding the bed sheets, walls or floor ehere they gather dust and germs. Recuperated by busy nurses, aides and visitors or doctors, cleaners or anyone else passing by they are quickly slapped back on the face. How clean, hygienic and beneficial is that. Too costly, but perhaps a clean mask or tubes in its packaging should be beside every bed of patients on such treatment as there is not always time each time it falls off to run for a replacement. The practice of spraying them with disinfectant and then putting them straight back on the face and near the airways doesn't seem a good solution either.

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