Addenbrooke’s Hospital Implementation of the

BTS 2008 Emergency Oxygen Guidelines

– the story so far

Caroline Owen

Respiratory Nurse Specialist

Addenbrooke’s Hospital, Cambridge

Where have we been? 1990’s – 2005 – aimed at education

2005-2008 – reviewed process – stickers in charts

2008 – BTS guidelines aimed to simplify and improve oxygen administration

2009 – NPSA alert No prescription Poor monitoring of the patient Incorrect administration – confusing air and oxygen flow

meters Equipment – empty cylinders

2010 – Addenbrooke’s guideline

2012 – Never event

2014 – E-hospital

Implementation posters

Data Assessed

Ad’brooke

2013

National

2013Ad’brooke

2012National

2012Ad’brooke

2011Nationally2011

Ad’brooke

2010

% of patients using oxygen with a prescription with a target range

94% 55% 94% 46% 75% 48% 72%

% of signatures to drugs rounds

87% 21% 76% 20% 61% 20% 32%

% of observations to rounds

123% 100% 106% 100% 108% 100% 96%

% of patients within target range

74% 64% 78% 57% 75% 67% 61%

BTS Oxygen Audit 2013 - Summary of data collected in comparison to National data and previous data collected

Challenges Signing drug chart

Oxygen titration (audit poor to identify)

ED

Ambulance Services – ‘Alert’ cards

Surgery

Resuscitation guidelines & Oxygen guidelines

Airflow meter confusion

Air Flow Meter’s Concerns over confusing oxygen and air flow

meters

2011 audit - 384 beds checked – 106 air meters in-situ – majority not being used

STANDARD REQUIRED: Air flow meters should be taken out of the wall

when not in use Air flow meters should be kept in a dedicated

place Air flow meters need high-lighting they are air

and not oxygen

Airflow meter covers

IT’S BLACK

AND LABELLED

“AIR”A new

cover to help remind

you it is air

BEWARE! DON’T CONFUSE OXYGEN AND AIR FLOW METERS!

IT’S WHITE AND

LABELLED “O2”

AIRFLOW METERS• REMOVE WHEN NOT IN USE• KEEP IN A SPECIAL ALLOCATED PLACE IN YOUR AREA

OXYGEN FLOW METERS• KEEP IN THE WALL IN CASE OF EMERGENCIES

Electronic Hospital

Mandatory for all trusts by 2020 to be paperless

Addenbrooke’s introduced an electronic system using Epic software in October 2014

Other hospitals have chosen different software

We no longer use paper and all communication, charting and prescribing is done on the computers

Access from inside the hospital and outside; on laptops, smart phones and i-pads

E-hospital considerations for oxygen prescribing

What requirements must be fulfilled?

Highlight these early on in the design

When should oxygen be prescribed – on arrival into ED or later when patient is fully assessed?

What should it look like?

Should all patients be allocated a target saturation?

What alerts may you want to add?

E-hospital considerations for nurse administration

How should they see the oxygen prescription or order?

How frequently should they ‘sign’ for it?

Who should sign for it?

Vital sign frequency can be ‘ordered’

Which measures can be applied to improve safety?

Audit

Run a report for patients on oxygen

Adapt to needs of the BTS audit criteria

Potential Advantages

No paper – changes can be made without altering previous charts

Better record keeping – neater! Easy access Visual reminders for doctors to write up; nurses

to sign for. If out of range – alerts staff to address Easy audit Best practice alerts

Potential Disadvantages

Adapting to a new way of working

Many screens leads to information overload

Requires good data input

Conclusion Oxygen guidelines are now common place

Audit results are exceptional

No never events

It is the challenge of E-hospital to maintain and continue to improve processes

Any questions?