Covidien

As part of our continuous educational drive around Pulse Oximetry, Covidien would like to draw your attention to the new RAPID RESPONSE REPORT (NPSA/2009/RRR006): OXYGEN SAFETY IN HOSPITALS which was recently published by the UK National Patient Safety Agency (NPSA).


The primary aim of the NPSA is to lead and contribute to improved, safe patient care by informing, supporting and influencing organisations and people working in the health sector.
As stated on the NPSA website (http://www.npsa.nhs.uk/), the Oxygen Safety in Hospitals Alert document has been released to all NHS acute, community and mental health organisations, as well as the independent sector. This follows reports received by the NPSA of 281 serious incidents between December 2004 and June this year.  Of these incidents, poor oxygen management appears to have caused nine deaths and may have contributed to a further 35 deaths.

 

Common incidents that were highlighted within the reports include:

  • Failure or wrongly prescribed dosage
  • Failure to monitor oxygen blood concentration
  • Confusion of oxygen with compressed air
  • Empty cylinders, faulty and missing equipment

 

The new guidance has been released after it was produced following joint working between the NPSA and NHS organisations across England. It is intended to ensure:

  • Staff follow clinical guidelines on safe prescribing of oxygen and monitoring of all patients
  • The use of oxygen cylinders is minimized in favour of safer (and cheaper) piped oxygen, where appropriate
  • Action is taken to reduce risks of confusion between air and oxygen
  • Multidisciplinary groups are tasked with developing safer systems for oxygen across hospitals

 

Professor Mike Morgan, Chair of the British Thoracic Society (BTS) has stated: The British Thoracic Society is currently supporting the implementation of our recent UK Guideline for Emergency Oxygen use in adults, which has been endorsed by 21 other royal colleges and societies. The guidance says that oxygen should be prescribed like any other drug (except in serious emergencies) and its use should be monitored using pulse oximeters which are now widely available. The goal of oxygen treatment is to achieve safe oxygen saturation (94 - 98 per cent) for most acutely ill people.  However oxygen therapy may have significant risks for vulnerable respiratory patients where a lower target saturation (88 - 92 per cent) is required.  The BTS has appointed 'Oxygen Champions' in most acute UK hospitals to help introduce the guidelines to improve oxygen use, enhance patient safety and audit usage.
National documents are available providing advice on the safe use of oxygen; these are:

 

British Thoracic Society (October 2008): Guidelines for emergency oxygen use in adult patients
These comprehensive clinical guidelines cover all aspects of the emergency use of oxygen in pre-hospital care and hospital settings. Note that they do not cover children under 16 years or critical care (ITU and HDU facilities). The key recommendations are: o Oxygen therapy will be adjusted to achieve target saturations rather than giving a fixed dose to all patients with the same disease. o Nurses will make these adjustments without requiring a change to the prescription on each occasion. o Most oxygen therapy will be from nasal cannulae rather than masks. o Oxygen will not be given to patients who are not hypoxaemic (except during critical illness). o Pulse oximetry must be available at all locations where emergency oxygen therapy is used. o Oxygen will be prescribed in all situations except for the immediate management of critical illness.


In Appendix 2 of the report, a number of resources and good practice examples relating to the key risks and actions recommended are stated including:
Action 6: Pulse oximetry is available in all locations where oxygen is used.


It is recommended in the BTS guidelines that:

  • Pulse oximetry must be available in all locations where emergency oxygen is used;
  • Oxygen saturation, ''the fifth vital sign'', should be checked by pulse oximetry in all breathless and acutely ill patients (supplemented by blood gases when necessary) and the inspired oxygen concentration should be recorded on the observation chart with the oximetry result (the other vital signs are pulse, blood pressure, temperature and respiratory rate);
  • All patients should have their oxygen saturation observed for at least five minutes after starting oxygen therapy.