Policy for the Prescription, Administration and Monitoring Of Oxygen ...

More documents

Recommendations

Info

‣ Patients receiving oxygen as part of palliative care, or patients on the end of life carepathway (in which case the prescriber should choose 'target saturations not indicated'on the drug chart/JAC EPMA system).6.7. Specialist areasThis policy is for general use within general wards and department. Where specific clinicalguidelines are required oxygen administration within specialist areas, they must beapproved via the appropriate clinical governance forum. They should reflect whereverpossible the principles within this policy. Patients transferring from specialist areas mustbe transferred with a prescription for their oxygen therapy utilising target saturation if theclinical indication is ongoing. If a patient transfers from an area not utilising the targetsaturation system, their oxygen should be administered as per the transferring area'sprescription until the patient is reviewed and transferred over to the target saturationscheme and this should occur as soon as possible.6.8. IndicationsThe rationale for oxygen therapy is prevention of cellular hypoxia, caused by hypoxaemia(low PaO 2 ) and thus prevention of potentially irreversible damage to vital organs.Oxygen is not a treatment for breathlessness and other caused of tissue hypoxia e.g.anaemia, ischaemia must be addressed. Indications for oxygen therapy are listed inAppendix a.6.9 Contra-indicationsThere are no absolute contra-indications to oxygen therapy if indications are judged to bepresent. the goal of oxygen therapy is to achieve adequate tissue oxygenation using thelowest possible Fi0 2 . Supplemental oxygen should be administered with caution inpatients suffering from paraquat poisoning and with acid inhalation or previous belomycinlung injury.6.10 Cautions6.10.1 Oxygen induced hypercapniaA subgroup of patients with chronic obstructive pulmonary disease will develop oxygeninduced hypercapnia. Other at risk groups include neuromuscular disorders, morbidobesity and chest wall deformities. These high risk patients must be administered withcontrolled oxygen only and regular blood gases should be performed to monitor PaCO 2and pH if oxygen therapy is increased.6.10.2 Other complications of oxygen therapy‣ Coronary and cerebral artery vascoconstriction‣ Pulmonary toxicity‣ Drying of nasal and pharyngeal mucosa‣ Skin irritation‣ Fire hazard‣ Pressure sores resulting from the delivery device.Policy for the prescription, administrationand monitoring of emergency oxygen in adultsPage 6 of 34
6.11 Transfer and transportation of patients receiving oxygenPatients who are transferred from one area to another must have clear documentation oftheir ongoing oxygen requirements and documentation of their oxygen saturation. If apatient transfers from one area not utilising the target saturation system (see specialistareas above) their oxygen should be administered as per the transferring areasprescription until the patient is reviewed and transferred to the target saturation schemeand this should occur as soon as possible.Patients requiring oxygen therapy while being transferred from one area to another shouldhave oxygen therapy reviewed prior to leaving the clinical area and on return by trainednursing staff. Clear instructions must be provided for personnel involved in the transfer ofthe patient, which must include delivery device and flow rate. Please also refer to thePortering Services policy on Changing Medical Gas Cylinders.6.12 Peri-operative and immediately post operativelyTheatres and recovery follow the AAGBI guidelines [ref 3,4] with respect to oxygenadministration.However, when patients are transferred back to the ward from recovery, oxygen shouldbe prescribed on the RCHT drug chart as discussed in Section 6.6.13 Nebulised therapy and oxygenWhen nebulised therapy is administered to patients at risk of hypercapnic respiratoryfailure, (see Section 6.10.1) , it should be driven by compressed air. if necessarysupplementary oxygen should be given concurrently by nasal prongs at 1 - 4 litres perminute to maintain an oxygen saturation of 88 - 92% or their specified target range.All patients requiring 35% or greater oxygen therapy should have their nebulised therapyby oxygen at a flow rate of >6 litres/minute.6.14 Normal oxygen saturations‣ In adults less than 70 years of age at rest at sea level 96 - 98% when awake.‣ Aged 70 and above at rest at sea level greater than 94% when awake.‣ Patients of all ages may have transient dips of saturation to mid-80's% during sleep.6.15 Summary oxygen administration protocol (and weaning protocol)ACTIONAll patients requiring oxygen therapy willhave a prescription for oxygen therapyrecorded on the patients drug prescriptionchart or JAC EPMA system. N.B.Exceptions - see emergency situations.The prescription will incorporate as targetsaturation that will be identified by theclinician prescribing the oxygen inRATIONALEOxygen should be regarded as a drug andshould be prescribed. BTS NationalGuidelines (2008). British Formulary(2012).Certain groups of patients require differenttarget ranges for their oxygen saturation,see Appendix a: Tables 1 - 4.Policy for the prescription, administrationand monitoring of emergency oxygen in adultsPage 7 of 34
Page 2 and 3: Table of Contents1. Introduction ..
Page 5: provided for those administering ox
Page 9 and 10: well perfusedSaturation within targ
Page 11 and 12: Appendix 1. Governance InformationD
Page 13 and 14: Appendix 2.Initial Equality Impact
Page 15 and 16: APPENDIX a. Indications for oxygen
Page 17 and 18: Deterioration of lung fibrosisor ot
Page 19 and 20: CF (cystic fibrosis); COPD (chronic
Page 21 and 22: Poisoning with paraquat orbleomycin
Page 23 and 24: Appendix c. Administering oxygen th
Page 25 and 26: Venturi MasksDESCRIPTIONA mask inco
Page 27 and 28: Reservoir (non-rebreathe) maskDESCR
Page 29 and 30: Oxygen flow meterDESCRIPTIONDevice
Page 31 and 32: Appendix f Personnel who mayadminis
Page 33 and 34: Appendix (h)HEALTH AND SAFETYAction

Policy for the Prescription, Administration and Monitoring Of Oxygen ...

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?