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Arch Intern Med. 1996 Sep 9;156(16):1797-801.

Multidisciplinary education for oxygen prescription. A continuous quality improvement study.

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1
Department of Medicine, McMaster University Faculty of Health Sciences, Hamilton, Ontario.

Abstract

OBJECTIVES:

To examine the oxygen-prescribing habits and monitoring patterns on a medical teaching ward and to review the literature in this area.

DESIGN:

A continuous quality improvement study.

SETTING:

A 29-bed medical clinical teaching unit in a 453-bed university-affiliated tertiary care hospital.

PATIENTS:

We studied 50 consecutive patients who required 79 oxygen treatments.

METHODS:

We recorded the indication, prescriber, documentation of prior hypoxemia, method and mode of delivery, oxygenation assessment after initiation, and duration of therapy.

RESULTS:

Patients received oxygen for a mean (+/- SD) of 4.7 +/- 4.5 days. Oxygen therapy was ordered on a continuous basis 60.3% of the time. It was ordered by house staff in 54 cases (68%); nurses initiated oxygen therapy in 14 cases (18%) but discontinued it more often than any other health care workers. The most common indications for starting oxygen therapy were dyspnea and tachypnea. In 15 patients (30%), none of the American College of Chest Physicians and National Heart, Lung, and Blood Institute criteria for starting oxygen therapy were fulfilled. For 16 patients (32%), arterial blood gas values were measured within 1 hour of oxygen administration; for 29 patients, oximetry was performed. For 9 patients (18%), no testing of adequate oxygenation was performed within 24 hours. Oxygenation status was assessed daily for 23 patients (46%).

CONCLUSIONS:

Oxygen prescribing and monitoring practices were suboptimal on our busy medical teaching ward. Practice guidelines based on best available evidence are needed to increase the efficiency of oxygen use. A physiologic, multidisciplinary educational focus on the benefits and hazards of supplemental oxygen is necessary, and randomized trials of such educational interventions should be conducted.

PMID:
8790073
[Indexed for MEDLINE]

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