Using patient specific protocols (PSP) to achieve appropriate oxygenation in patients at risk of oxygen toxicity; from ambulance through to inpatient stay

Abstract

Introduction and objectives The London Ambulance Service(LAS) uses Patient Specific Protocols(PSPs) as directives for a range of conditions. Since 20061 we have worked with LAS using PSPs to prevent oxygen(O2) toxicity during ambulance transfer in patients at risk of type 2 respiratory failure. PSPs are now ‘flagged’ on our records which may also influence hospital oxygen prescribing. The aim of this study was to evaluate PSP effectiveness in influencing appropriate O2 prescribing during both ambulance transfer and hospital stay. Methods Data from 50 patients identified as at risk of oxygen toxicity(disease severity and/or raised bicarbonate) who had PSPs initiated sequentially pre-May 2017 were reviewed for; initiation bicarbonate, ED attendances, prescription and delivery of O2 in ambulance/ED/wards, and death in the subsequent year. Results Hospital records were reviewed for 43/50 (86%) patients with PSPs. Patient characteristics are shown in table 1. In the year post-PSP 20/43 (46.5%) had ≥1 hospital attendance (overall 44 attendances); there were 2 deaths(not O2-related). LAS data were available for 34/44 (77%) attendances. 30/34 (88.2%) were appropriately oxygenated during ambulance transfer. 4/34 (11.8%) had saturations above target range; of these, 2/4 had immediate action taken. In ED 34/34 (100%) patients had documented alert of O2 sensitivity and 34/40 (85%) had appropriate oxygenation. 5/40 (12.5%) had saturations above target range and 1/40 (2.5%) saturations below range; of these, 4/6 had corrective action taken to restore saturations towards target range. 21/34 (61.8%) had specified O2 prescription in ED. On ward transfer, 34/36 (94%) had saturations in range; 1/36 (2.7%) above target range, with corrective action not taken and 1/36 (2.7%) below target, with corrective action taken. 32/34 (94.1%) had ward O2 prescriptions. Conclusions PSPs continue to be an effective mechanism for ensuring safe oxygenation during ambulance transfer of at risk patients. Patients were identified appropriately for PSP; almost half were admitted in the subsequent year. Having a PSP flagged on their records also enabled safe O2 prescription and delivery from arrival in ED through to inpatient wards. While PSPs are an agreed Londonwide Ambulance tool to prevent oxygen toxicity, their impact on patient safety appears to be far wider reaching than ambulance transfer. https://thorax.bmj.com/content/73/Suppl_4/A198.2 This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ http://dx.doi.org/10.1136/thorax-2018-212555.337