Improvements and Shortcomings in Emergency Oxygen Prescribing: A Quality Improvement Initiative at an Acute Tertiary Care Hospital

Abstract

Oxygen is one of the most commonly used yet poorly prescribed drugs. The 2015 British Thoracic Society (BTS) emergency oxygen audit highlighted the national shortcomings in oxygen prescribing and administration. A 2017 local audit at the Royal Sussex County Hospital, Brighton, UK, continued to demonstrate poor compliance with the BTS Oxygen Prescribing Guidelines in all areas audited. This study carried out yearly reaudits in November 2018 and 2019 to objectively measure the impact of implementing trust-wide and local interventions (July 2018 and August 2019).Intervention 1 included introduction of the National Early Warning Score (NEWS2) scale and redesigning drug charts with tick-boxes for target oxygen saturations. Intervention 2 included mandatory junior doctor teaching on safe oxygen prescribing, ‘oxygen safety’ posters on audited wards, and reminders at handover for staff to measure and document oxygen saturations.Following Intervention 1, all patients with valid oxygen prescriptions had a specified target saturations range. Intervention 2 ensured all patients had actual saturations within their prescribed target range, and 99% had oxygen saturations documented with sufficient frequency for their NEWS2 score. These were huge improvements from previous audits, during which a significant proportion of patients were at risk of hypercapnia, and those over- or underoxygenated were left unrecognised for hours. Despite improvements, 14% of patients continued to use oxygen without valid prescriptions in 2019, and drug charts were inconsistently signed for during drug rounds.Although the implemented changes enabled drastic improvements for patient safety and quality in oxygen use, future work should ensure oxygen is always treated as a drug with suitable prescription and documentation.