| Popis: |
Background As a respiratory team we provide annual reviews for local patients prescribed home oxygen. The aim of these reviews is to optimise oxygen benefit, reduce risk of harm, and address gaps in value-based interventions. We developed and introduced a Home Oxygen Review Proforma to support this approach. The aim of this study was to evaluate the impact of this proforma as an enabler of high-value COPD interventions and patient safety. Methods All 2019 Home Oxygen Review Proformas completed for patients with COPD were analysed for: demographics, spirometry, oxygen saturations on air (SpO2) and carbon monoxide (CO) readings; and actions taken following review: value-based interventions (influenza vaccination, tobacco dependence treatment, referral to pulmonary rehabilitation (PR)) and ‘oxygen alerts’ (Patient Specific Protocols (‘PSPs’)) for patients with raised serum bicarbonate. Results 52/55 (26M;26F) patients with COPD prescribed oxygen were reviewed at home. Mean age was 73 (range 52–89) years. Mean (SD) FEV1 was 0.71 (0.37) L; n=52, FVC 1.59 (0.77) L; n=51 and SpO2 87(5)%; n=50. Smoking status was confirmed with CO testing; 43/50 (86%) normal (0–4 ppm); none with CO>10ppm (smoking). 7/50 (14%) were ‘possibly smoking’ (5–9ppm) with no evidence of smoking in home, hence monitored. 39/52 (75%) patients were up-to-date with influenza vaccination; 9/52 (17%) were referred for vaccination; 4 declined vaccination offer. 40/52 (77%) had previously completed PR; 7/52 (13%) were referred for PR; 3 declined referral; 2 did not meet criteria. 46/52 had serum bicarbonate measured: raised in 27/46 (59%); 19 had ‘PSP’ already and 7 (26%) were referred for new ‘PSP’ to prevent oxygen poisoning. Discussion This Home Oxygen Review Proforma for patients with COPD using home oxygen was an enabler of increased safety; specifically CO validation of smoking status, and serum bicarbonate identifying nearly 60% of patient as at risk of oxygen poisoning. While the majority of patients reviewed had received value-based interventions, it was also an effective way to identify gaps;17% had missed out on, and were referred for: influenza vaccination, 13% referred for PR and 26% for a ‘PSP’. This proforma is now used for all home oxygen reviews across two CCGs. |
