<p>Understanding Clinicians’ Perceived Barriers and Facilitators to Optimal Use of Acute Oxygen Therapy in Adults</p>

Abstract

Background: Supplemental oxygen is commonly administered to patients in acute care. It may cause harm when used inappropriately. Guidelines recommend prescription of acute oxygen, yet adherence is poor. We aimed to identify barriers and facilitators to practicing in accordance with the evidence-based Thoracic Society of Australia and New Zealand (TSANZ) oxygen guideline, and to determine the beliefs and attitudes relating to acute oxygen therapy. Methods: A national cross-sectional survey was conducted. The survey consisted of 3 sections: (1) introduction and participant characteristics; (2) opinion/beliefs, knowledge and actions about oxygen therapy and other drugs; and (3) barriers and facilitators to use of the TSANZ guideline. Convenience sampling was employed. A paper-based survey was distributed at the TSANZ Annual Scientific Meeting. An online survey was emailed to the TSANZ membership and to John Hunter Hospital's clinical staff. Results: Responses were received from 133 clinicians: 52.6% nurses, 30.1% doctors, and 17.3% other clinicians. Over a third (37.7%) were unaware/unsure of the oxygen guideline's existence. Most (79.8%) believe that oxygen is a drug and should be treated as one. Most (92.4%) stated they only administered it based on clinical need. For four hypothetical cases, there was only one where the majority of participants identified the optimal oxygen saturation. A number of barriers and facilitators were identified when asked about practicing in accordance with the TSANZ guideline. Lack of oxygen equipment, getting doctors to prescribe oxygen and oxygen being treated differently to other drugs were seen as barriers. The guideline itself and multiple clinician characteristics were considered facilitators. Conclusion: There is discordance between clinicians' beliefs and actions regarding the administration of oxygen therapy and knowledge gaps about optimal oxygen therapy in acute care. Identified barriers and facilitators should be considered when developing evidencebased guidelines to improve dissemination and knowledge exchange.

Doctors’ and Nurses’ Knowledge and Perceived Barriers Regarding Acute Oxygen Therapy in a Tertiary Care Hospital in Nigeria

“…This result is supported by other studies showing significant knowledge gaps among healthcare staff. [24][25][26][27][28] These findings could affect the assessment and optimal delivery of oxygen and the outcome of acutely ill patients. The poor understanding of AOT in this study was because most doctors and nurses lack awareness of and familiarity with the available international AOT guidelines and perhaps the absence of a local protocol and national guideline for oxygen administration.…”

Cuidados de enfermería ante la necesidad de oxigenación en adultos con enfermedad por COVID-19:

“…En la revisión integrativa se encontró una variedad de cuidados de enfermería enfocados a atender la necesidad de oxigenación, la cual está estrechamente relacionada con los procesos de respiración, ya que el aporte de oxígeno es fundamental en la homeostasis del sistema cardio-respiratorio. Pan et al (2020), implementaron una estrategia de oxigenoterapia que mejoró los resultados clínicos de los pacientes críticos (29), considerando que el oxígeno puede causar daño si se administra de forma inapropiada (35)(36). La hipoxemia es frecuente en pacientes con enfermedad por COVID-19, por lo que Perkins et al (2021), describieron recomendaciones dirigidas a enfermeros que brindan cuidado en la primera línea de atención (30).…”

A human factors approach to quality improvement in oxygen prescribing

“…While some of the barriers and enablers to oxygen prescription -such as knowledge, availability of equipment and treatment of oxygen as different from other drugs -have been observed before, adding a human factors perspective using FRAM brought new understanding and ideas to the change initiative. 8 For example, in all other elements of prescribing, pharmacists exert significant control, but they were not actively involved in aiding oxygen prescribing control. There were also obvious tensions between the ease of oxygen delivery and the requirement to make oxygen available for medical emergencies, and the regulatory requirement that oxygen should be prescribed before administration or the costing of oxygen delivery.…”