A Two-Cycle Audit of Oxygen Prescription in Hospitalised Patients Receiving Supplemental Oxygen: A Retrospective Study

TL;DR

This study found that most hospitalized patients receiving oxygen lacked proper prescriptions, but simple interventions improved compliance slightly.

Contribution

A two-cycle audit and interventions to improve oxygen prescription practices in hospital settings.

Findings

Only 19% of patients had appropriate oxygen prescriptions in the first audit cycle.

After interventions, 34% of patients had valid prescriptions, showing a statistically significant improvement.

Rotating resident doctors hinder long-term compliance with oxygen prescription guidelines.

Abstract

Background

Supplemental oxygen therapy is an essential intervention for patients with respiratory insufficiency, but its prescription and documentation are often inconsistent. Oxygen is considered a drug, and improper prescribing or absent documentation can result in inadequate oxygen delivery, potentially leading to harmful effects. Despite national guidelines recommending target oxygen saturation ranges for patients, previous audits, such as the 2015 British Thoracic Society study, indicated significant gaps in oxygen prescription practices across hospitals. The aim of this audit was to assess the accuracy of oxygen prescriptions in hospitalised patients receiving supplemental oxygen, and to evaluate the effectiveness of interventions designed to improve compliance.

Methods

This audit was conducted at Victoria Hospital, Kirkcaldy (NHS Fife), UK, during the first and second weeks of November 2024. A retrospective, cross-sectional study design was used, and data were collected from 69 patients who were receiving supplemental oxygen in the acute medical and general medical wards. Exclusion criteria involved patients under 18 years old, those admitted to specialised units such as A&E, MHDU, or ICU, and patients not receiving supplemental oxygen.

Results

In the first audit cycle, only 19% of the 69 patients receiving supplemental oxygen had an appropriate prescription documented on their medication chart. The majority of patients lacked any formal documentation regarding their oxygen therapy. Following this, two interventions were implemented: a poster campaign to raise awareness about oxygen prescription requirements and a mass email reminder to resident doctors. In the second audit cycle, with a sample size of 77 patients in the same acute and general medical wards, the proportion of patients with a valid oxygen prescription increased to 34%, indicating a positive trend towards improved compliance; it is statistically significant (p-value = 0.04). A p-value <0.05 is considered statistically significant.

Discussion

This audit underscores the ongoing challenge in ensuring adequate oxygen prescription practices in hospitals. Despite clear guidelines and local policies, the initiation of oxygen therapy frequently occurs without a corresponding prescription. The improvement seen after simple educational interventions suggests that targeted strategies can enhance staff compliance, but further efforts are necessary. A notable barrier is the rotation of resident doctors every four months, which disrupts continuity and diminishes the long-term effectiveness of interventions.

Conclusion

While compliance with oxygen prescription among hospitalised patients remains suboptimal, interventions such as awareness campaigns and email reminders have shown some success in improving practices. Ongoing education and regular re-auditing are crucial to ensure continued adherence to best-practice guidelines, ultimately enhancing patient safety and care quality.

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