All patients who are being considered for long-term oxygen treatment (LTOT) at home should have a thorough risk assessment delivered by trained staff, according to new national standards.
The assessment should include a review of the risk of fire, trips and falls from using oxygen within the home, said the British Thoracic Society (BTS).
“Healthcare professionals can make decisions based on latest available evidence and best practice”
As part of the process, the smoking status of patients and other household members should be recorded – with safety advice and smoking cessation support supplied as appropriate, it said.
The BTS is encouraging use of its new Quality Standards for Home Oxygen Use in Adults by commissioners, healthcare practitioners and patients to ensure “best possible clinical care”.
The standards also advise that all patients receive a blood gas “check-up” three months after the initiation of therapy, to assess the effectiveness, and future need, of LTOT at home.
In addition, patients should receive regular ongoing checks by a home oxygen assessment service, at least on an annual basis, as well as education and information supplied by a specialist team.
The BTS Quality Standards for Home Oxygen Use in Adults – taken from its 2015 Guideline on Home Oxygen Use in Adults – offer 10 quality statements summarising the latest, evidence-based practice.
“It is vital that home oxygen is administered and reviewed effectively”
Among others, they are endorsed by the Association of Respiratory Nurse Specialists, the Association of Palliative Medicine and the Primary Care Respiratory Society UK.
Latest figures show that around 85,000 people in England have oxygen at home. It is typically prescribed for those with heart or lung conditions who continue to have low blood oxygen levels after all other medical treatments have been given.
Dr Jay Suntharalingam, co-chair of the BTS Home Oxygen Quality Standard Development Group, said: “We’re delighted that the BTS quality standards for home oxygen use in adults are now available, so that healthcare professionals can make decisions based on latest available evidence and best practice.
“Home oxygen can be a highly effective treatment for common lung conditions, including chronic obstructive pulmonary disease, when blood oxygen levels are low,” he said. “This allows those affected to enjoy a better quality of life and can potentially improve life expectancy.
“However, as with all specialist treatments, it is vital that home oxygen is administered and reviewed effectively to ensure the safety and best health outcome for patients. The new quality standards provide an outstanding framework for achieving this,” he added.
BTS Quality Standards for Home Oxygen Use in Adults:
- All patients should have home oxygen assessment, carried out by a home oxygen assessment service that includes appropriately trained staff and appropriate equipment
- All patients being assessed for home oxygen should undergo a risk assessment that includes assessment of individual and household member smoking status, and other household risks of fire, trips and falls
- All patients initiated on home oxygen should have appropriate education and written information provided by a specialist home oxygen assessment team
- Patients with advanced stable cardiorespiratory disease who have resting saturations on air that meet the qualifying criteria - should be referred for an LTOT assessment
- All patients being considered for LTOT should undergo serial blood gas assessments, by the home oxygen assessment service, when stable to confirm both the need for and tolerability of LTOT
- Review, reassessment and withdrawal: all patients started on LTOT should be followed up with blood gas assessment within three months of initiation of therapy; this includes those patients who are discharged home from hospital on LTOT for the first time. All patients who continue on LTOT should be monitored at least on an annual basis by a home oxygen assessment service. All patients who are identified as no longer requiring any form of home oxygen should have this withdrawn
- Short burst oxygen therapy (SBOT) should only be offered in the context of cluster headache. SBOT should not be ordered for patients with chronic cardiorespiratory disease
- Nocturnal oxygen therapy (NOT): Patients with optimally treated cardiac failure, who are not eligible for LTOT, should only be offered NOT if there is evidence of sleep disordered breathing causing daytime symptoms. Patients with chronic hypercapnic respiratory failure with night-time hypoxemia (an abnormally low concentration of oxygen in the blood) who are not eligible or LTOT, should only be offered NOT in conjunction with non-invasive ventilation (NIV)
- Ambulatory oxygen therapy (AOT) – i.e. use of portable oxygen – including outside the home: Patients not eligible for LTOT should only have AOT ordered to facilitate pulmonary rehabilitation or to improve mobility after appropriate formal assessment that includes an exercise test. Patients on LTOT, who are mobile outdoors, should only be offered AOT if this allows them to achieve 15 hours/day compliance with LTOT and/ or improve capacity to undertake outdoor activities
- Palliative oxygen therapy (POT) can be considered as a trial for patients with hypoxaemia (saturations <92% on air) with refractory dyspnoea due to life-limiting disease that has not responded to opioids and non-pharmacological therapy, for example, fan therapy