An audit of oxygen therapy on a respiratory ward

Hickey, Steven

doi:10.12968/bjon.2007.16.18.27507

Cited by 16 publications

(15 citation statements)

References 8 publications

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“…Figure 1 depicts a timeline of papers (according to the geographical area that the studies were conducted) that have been published on oxygen therapy prescription and administration practices since 1980. Interestingly, over 27 years, between 1980 and 2007, 17 papers 33 , 35 , 41 – 44 , 46 , 47 , 49 – 51 , 53 – 58 were found that discussed oxygen prescription rates and/or the appropriateness and accuracy of oxygen administration and subsequent monitoring of oxygen therapy. In the 6 years between 2009 and 2015, 12 papers which measured the accurate or appropriate prescription of oxygen therapy have been reported.…”

Section: Oxygen Prescriptionmentioning

confidence: 99%

Acute oxygen therapy: a review of prescribing and delivery practices

Cousins

Wark

McDonald

2016

COPD

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Oxygen is a commonly used drug in the clinical setting and like other drugs its use must be considered carefully. This is particularly true for those patients who are at risk of type II respiratory failure in whom the risk of hypercapnia is well established. In recent times, several international bodies have advocated for the prescription of oxygen therapy in an attempt to reduce this risk in vulnerable patient groups. Despite this guidance, published data have demonstrated that there has been poor uptake of these recommendations. Multiple interventions have been tested to improve concordance, and while some of these interventions show promise, the sustainability of these interventions are less convincing. In this review, we summarize data that have been published on the prevalence of oxygen prescription and the accurate and appropriate administration of this drug therapy. We also identify strategies that have shown promise in facilitating changes to oxygen prescription and delivery practice. There is a clear need to investigate the barriers, facilitators, and attitudes of clinicians in relation to the prescription of oxygen therapy in acute care. Interventions based on these findings then need to be designed and tested to facilitate the application of evidence-based guidelines to support sustained changes in practice, and ultimately improve patient care.

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Section: Oxygen Prescriptionmentioning

confidence: 99%

Acute oxygen therapy: a review of prescribing and delivery practices

Cousins

Wark

McDonald

2016

COPD

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“…Errors in the delivery of Oxygen can have serious clinical consequences, particularly the precipitation of type II respiratory failure. Despite this, Oxygen prescription is often poorly achieved, leaving patients at risk of the adverse effects of inappropriate Oxygen delivery.…”

Section: Introductionmentioning

confidence: 99%

Doctors learn new tricks, but do they remember them? Lack of effect of an educational intervention in improving Oxygen prescribing

et al. 2015

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Background and objective: The 'audit cycle' is a fundamental part of improving clinical performance. For this to be effective, improvements made must be sustained. We observed that the prescription of Oxygen is often poor. Our aim was to audit Oxygen prescription before and after an educational intervention, and then again 4 years on. We hypothesized that improvements made immediately after the intervention would not be sustained over a longer period of time. Conclusions: The rate of Oxygen prescription improves significantly after an educational intervention; however, this improvement is not sustained. This observation is likely reflected in a range of areas where the audit cycle is used to improve performance. It is important to be aware of this potential for regression to ensure that improvements are maintained over time.

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“…In the cardiovascular system, short-termSI hyperoxia has been reported to reduce coronary blood flow (McNulty et al, 2005) and myocardial O 2 uptake (Ganz et al, 1972). Despite these outcomes, which could be harmful to the patient, O 2 therapy is used in approximately 800 000 patients per year (Kim et al, 2008) and its mismanagement has been suggested to result in treatment errors that exceed the use of antibiotics (Boyle & Wong, 2006; Brokalaki et al, 2004; Hickey, 2007). This highlights the urgency for understanding the mechanisms for susceptibility to hyperoxia.…”

Section: Introductionmentioning

confidence: 99%

Cardiac responses to 24 hrs hyperoxia inBmp2andBmp4heterozygous mice

Howden

Cooley

Dodewaard

et al. 2013

Inhalation Toxicology

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Background: Hyperoxia or clinical oxygen (O2) therapy is known to result in increased oxidative burden. Therefore, understanding susceptibility to hyperoxia exposure is clinically important. Bone morphogenetic proteins (BMPs) 2 and 4 are involved in cardiac development and may influence responses to hyperoxia. Methods: Bmp2+/−, Bmp4+/− and wild-type mice were exposed to hyperoxia (100% O2) for 24 hrs. Electrocardiograms (ECG) were recorded before and during exposure by radio-telemetry. Results: At baseline, a significantly higher low frequency (LF) and total power (TP) heart rate variability (HRV) were found in Bmp2+/− mice only (p<0.05). Twenty-four hours hyperoxia-induced strain-independent reductions in heart rate, QTcB and ST-interval and increases in QRS, LF HRV and standard deviation of RR-intervals were observed. In Bmp4+/− mice only, increased PR-interval (PR-I) (24hrs), P-wave duration (P-d; 18 and 21–24hrs), PR-I minus P-d (PR-Pd; 24 hrs) and root of the mean squared differences of successive RR-intervals (24 hrs) were found during hyperoxia (p<0.05). Discussion: Elevated baseline LF and TP HRV in Bmp2+/− mice suggests an altered autonomic nervous system regulation of cardiac function in these mice. However, this was not related to strain specific differences in responses to 24 hrs hyperoxia. During hyperoxia, Bmp4+/− mice were the most susceptible in terms of atrioventricular conduction changes and risk of atrial fibrillation, which may have important implications for patients treated with O2 who also harbor Bmp4 mutations. This study demonstrates significant ECG and HRV responses to 24 hrs hyperoxia in mice, which highlights the need to further work on the genetic mechanisms associated with cardiac susceptibility to hyperoxia.

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An audit of oxygen therapy on a respiratory ward

Abstract: Current rates of oxygen prescribing remain unsatisfactory despite doctors being made aware of the audit findings. Education on oxygen therapy improved the delivery of oxygen therapy to patients on a respiratory ward.

Cited by 16 publications

References 8 publications

Acute oxygen therapy: a review of prescribing and delivery practices

Acute oxygen therapy: a review of prescribing and delivery practices

Doctors learn new tricks, but do they remember them? Lack of effect of an educational intervention in improving Oxygen prescribing

Cardiac responses to 24 hrs hyperoxia inBmp2andBmp4heterozygous mice

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