Oxygen prescription: improving compliance using methods from BMJ Open Quality journal

Abstract

Oxygen is an important drug frequently used in the management of acutely unwell hospital patients. However, oxygen overuse can have fatal side effects particularly for those patients at risk of iatrogenic hypercapnia. British Thoracic Society Guidelines state that oxygen must be prescribed for all patients, with target saturations stipulated on the prescription for patient safety. A quality improvement project was undertaken with the aim to improve the oxygen prescription rate across the respiratory ward at a district general hospital, over a period of 3 months. Quality improvement methods were implemented based on data analysis at each stage, following discussion with senior doctors and specialist nurses, and after reviewing previous quality improvement projects published on BMJ Open Quality. The initial interventions of poster reminders and multidisciplinary team education failed to significantly improve the rates of oxygen prescription. Use of a targeted intervention where stickers were placed above oxygen taps significantly improved prescription rate from 20% in the non-targeted group to 60% in the targeted group. This was based on a BMJ Open Quality published improvement method. The current guidelines from the British Thoracic Society, and hospital's own guidelines, advise good oxygen prescribing. However, these recommendations alone are ineffective at achieving compliance among prescribers. Further targeted interventions have shown improvements in oxygen prescriptions and could lead to better clinical practice, patient care and safety.

Keywords: compliance; healthcare quality improvement; pdsa; quality improvement methodologies.

Figure 1

Oxygen sign used for the first intervention.

Figure 2

Oxygen sign used for the third intervention.

Figure 3

Percentage of patients with oxygen prescriptions and documented target saturations at subsequent PDSA cycles. Blue bars represent percentage of patients with oxygen prescribed. Red bars represent patients with their target saturations documented either on electronic prescribing or the observation chart. Green bars represent patients at risk of iatrogenic hypercapnia with target saturations documented either on electronic prescribing or the observation chart. (PDSA= plan, do, study and act).

Figure 4

PDSA cycle 3 breakdown into intervention and non-intervention groups. Percentage of patients with oxygen prescriptions and documented target saturations. Blue bars represent percentage of patients with oxygen prescribed. Red bars represent patients with their target saturations documented either on electronic prescribing or the observation chart. Green bars represent patients at risk of iatrogenic hypercapnia with target saturations documented either on electronic prescribing or the observation chart.