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Nursing staff urged to use new guidance on giving emergency oxygen 'to save lives'

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Health professionals from across the NHS and beyond are being urged to adopt the latest version of the world’s first evidence-based guideline on the use of emergency oxygen.

The British Thoracic Society (BTS) Guideline for Oxygen Use in Adults in Healthcare and Emergency Settings was first published in 2008.

“It is very beneficial to many patients, but can be harmful if misused”

Ronan O’Driscoll

The updated version, endorsed by over 20 organisations, is based on new evidence about how effective prescribing and delivery of emergency oxygen can both improve health and save lives.

It advises health practitioners when prescribing oxygen to always specify a safe “target range” of oxygen in the blood, which can then be monitored.

This vital action is designed to ensure that patients are not given too little, or too much, oxygen which can result in greater illness and, in rare cases, even death, said the BTS.

Emergency oxygen is used to treat hypoxaemia that can cause damage to vital organs, and is associated with a number of lung diseases, such as pneumonia, asthma or chronic obstructive pulmonary disease. It is also used with other diseases such as heart failure and sepsis.

The updated guideline now covers emergency oxygen use as well as most other uses for it in healthcare settings, and also short-term use by healthcare workers outside of healthcare settings.

“We urge all clinicians to adopt the updated BTS guideline”

Ronan O’Driscoll

The new areas included are endoscopy and other procedures requiring sedation, care before, during and after operations including patient-controlled analgesia, and palliative care settings like hospices.

In addition, it covers the use of oxygen mixtures like Entonox – widely used in childbirth – and high-flow humidified nasal cannulae, and also the use of oxygen by healthcare professionals in patients’ homes and by voluntary rescue organisations and other first responders.

According to the BTS, evidence of the guideline’s effectiveness with regard to safe oxygen ranges has been increasing since it was first launched in 2008.

It quoted one trial and two observational studies showing that giving high concentration oxygen to patients with COPD can increase the likelihood of death as a result of acute exacerbations.

These studies support the case for the guideline’s recommendation of a lower safe “target range” of 88-92% oxygen saturation for patients with COPD, stated the BTS.

Another example cited by the BTS was heart attack patients with normal blood oxygen levels being given high concentration oxygen, which was common practice until very recently.

However, the BTS said it probably increases the size of the heart attack due to constriction of the blood vessels in the heart in response to high doses of oxygen.

It noted that there was also mounting evidence indicating that very high blood oxygen levels in intensive care unit patients were associated with increased death rates.

Senior guideline author Dr Ronan O’Driscoll, consultant respiratory specialist at Salford Royal NHS Foundation Trust, said: “Oxygen is a very important drug and should always be prescribed and monitored like any other medication.

“It is very beneficial to many patients, but can be harmful if misused,” he said. “We urge all clinicians to adopt the updated BTS guideline so that emergency oxygen is always used in an optimal and safe way.”

Oxygen respiratory

He added: “The guideline has now been extended to include more uses of oxygen ranging from procedures requiring sedation such as endoscopy, through to use of oxygen mixtures like ‘gas and air’ widely used in childbirth, to benefit an even greater number of patients.”

The BTS noted that one in seven patients in UK hospitals receives oxygen therapy for their condition on any given day.

But it said than 40% of such patients – about 6,000 a day – were receiving oxygen with no prescription or other written order to help staff deliver and monitor its use safely and effectively.

Furthermore, over half of hospitals do not provide sufficient training in oxygen provision and monitoring for doctors or nurses, warned the BTS.

However, the BTS said its most recent oxygen use audit in 2015 had found some “real progress”.

For example, it found that 85% of hospitals had implemented an oxygen policy and 100% used pulse oximeters to measure a patient’s oxygen levels on all nursing observation rounds.

Among others, the guideline has been endorsed by the Association of Respiratory Nurse Specialists, the Primary Care Respiratory Society and the Royal College of Nursing – granted until April 2020.

 

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