Oxygen Therapy in Ward: Implementation of a Prescription Protocol

Abstract

Introduction: Oxygen is one of the most used therapies in hospital environment, however, in Portugal there are no recommendations regarding its use in acutely ill patients. In the EMO Study (Neves, 2012) authors found that the use of oxygen in Portuguese Internal Medicine wards did not follow the legis artis. The aim of our study was to evaluate the impact of creating and implementing an oxygen therapy prescription protocol by target saturation range in an Internal Medicine Service.

Methods: A prospective study was carried out in two consecutive years, focusing on a representative sample of hospitalized patients, evaluating demographic variables, type of prescription, identification of the risk of hypercapnic respiratory failure, prescription compliance and administration failures.

Results: A total of 781 patients were included in the study, 583 (74.6%) had oxygen prescribed, of which 573 (98.3%) by target saturation range.  Two hundred thirty five (30.1%) patients with risk of hypercapnic respiratory failure were identified, which increased significantly in the last year of the study (26.7% vs 33.3%, p = 0.043). At the time of evaluation, 390 (77.4%) of the patients with a target saturation range prescription were on target. There was a significant increase in prescriptions for target range saturation (72.7% vs 99.6% in 2017 vs 97% in 2018, p = 0.017) and in the identification of patients at risk for hypercapnic respiratory failure (12.3% vs 26.7% in 2017 vs 33.3% in 2018, p = 0.002).

Conclusion: The creation of the prescription protocol and the training of the medical and nursing teams allowed for improved patient care, as can be seen by a significant improvement in the prescription by target range and in the identification of patients at risk for type 2 respiratory failure.