Aim The National Patient Safety Agency Rapid Response Report¹ and British Thoracic Society (BTS) guidelines² state that oxygen should be prescribed. Following the introduction of electronic prescribing in a specialist children’s hospital, there was a reduction in the number of patients whose oxygen was prescribed. A series of audits were undertaken to determine how often oxygen administration was accompanied by a valid prescription and whether a variety of interventions affected prescribing.

Method Eight paediatric wards in a specialist children’s hospital were included in the audit. Critical care and the Emergency Department were excluded. A total of 4 audits were completed across 16 months. Each audit comprised of a pharmacist visiting each ward on a single day and asking nurses which patients were receiving oxygen. The electronic prescription for each patient was then reviewed to determine whether oxygen was prescribed or not. Data was recorded and then analysed using descriptive statistics. Medical and nursing staff on the wards at the time of data collection were also asked for their views about the prescribing of oxygen.

Following the baseline audit, a variety of actions were introduced in order to improve the rate of prescribing including: a) Circulation of a hospital-wide Patient Safety Alert b) Highlighting oxygen prescribing at Ward Managers Meetings and Doctor Handovers c) Reminding all new doctors, nurses and pharmacists that oxygen must be prescribed and that prescribers should be challenged when oxygen isn’t prescribed d) Inclusion of oxygen prescribing in the Trust’s Medication Safety mandatory training

Results The baseline audit (November 2019) found 4.9% compliance with oxygen prescribed. At this point doctors described oxygen prescribing as ‘unnecessary work’. Junior nurses knew oxygen should be prescribed but did not believe it was their responsibility to chase prescribers. Following the introduction of remedial action (February 2020) compliance with oxygen increased to 39.1%. Repeat audits (December 2020 and April 2021) found compliance to be 53.8% and 42.1% respectively.

Conclusion Whilst compliance with oxygen prescribing has improved since the baseline audit, the Trust has not achieved the target of 80% compliance with oxygen prescribing. Contributing factors to this are the rapid turnover of medical and nursing staff and an apparent culture change is required to highlight the importance of oxygen prescribing amongst multi-disciplinary teams.

If an impactful change is to be made, it needs to be made clear to all groups that this is an important task. The key seems to be continual communication so that oxygen prescribing becomes routine across the Trust.

Action to be taken includes ensuring all relevant staff are aware of the need to prescribe oxygen; regular re-audit and sharing of the results with senior nursing, medical and pharmacy staff. The process for prescribing oxygen is now demonstrated during the introduction to electronic prescribing and we have started a Quality Improvement Project in conjunction with senior nurses on the ward who performed the worst across our audits.

References

1. National Patient Safety Agency. Rapid Response Report - Oxygen Safety in Hospitals. NPSA/2009/RRR006. Available at: https://www.sps.nhs.uk/wp-content/uploads/2011/08/RRR-Oxygen-safety-2009120092029_v1.pdf

2. O’Driscoll BR, Howard LS, Earis J, on behalf of the British Thoracic Society Emergency Oxygen Guideline Group, et al. BTS guideline for oxygen use in adults in healthcare and emergency settings. Thorax 2017;72:ii1-ii90.