Implementation of a multicomponent intervention to optimise patient safety through improved oxygen prescription in a rural hospital. (December 2014)

• Record Type: Journal Article
• Authors: Gunathilake, Roshan; Lowe, Deborah; Wills, James; Knight, Anne; Braude, Peter
• Is Part Of: Australian journal of rural health. Volume 22:Number 6(2014:Dec.)
• Page Start: 328
• Page End: 333
• Publication Date: 2014-12
• Subjects: Rural health -- Periodicals; Rural health -- Australia -- Periodicals; 613
• DOI: 10.1111/ajr.12115
• Languages: English
• ISSNs: 1038-5282

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="ajr12115-sec-0001" sec-type="section"> <title>Objective</title> <p>To rationalise oxygen procedures in adult medical and surgical inpatients with a view to improving patient safety.</p> </sec> <sec id="ajr12115-sec-0002" sec-type="section"> <title>Design</title> <p>Prospective pre‐ and post‐intervention audit.</p> </sec> <sec id="ajr12115-sec-0003" sec-type="section"> <title>Setting</title> <p>Manning Hospital, a rural referral hospital in Taree NSW.</p> </sec> <sec id="ajr12115-sec-0004" sec-type="section"> <title>Participants</title> <p>Pre‐intervention: 82 patients aged 72.7 <italic>±</italic> 14.7 years. Post‐intervention: 77 patients aged 73.6 <italic>±</italic> 12.4 years.</p> </sec> <sec id="ajr12115-sec-0005" sec-type="section"> <title>Intervention</title> <p>A multicomponent intervention composed of implementation of a local hospital oxygen policy, introduction of a specific oxygen prescription chart and targeted staff education.</p> </sec> <sec id="ajr12115-sec-0006" sec-type="section"> <title>Main outcome measures</title> <p>Satisfactory oxygen prescription, monitoring and titration.</p> </sec> <sec id="ajr12115-sec-0007" sec-type="section"> <title>Results</title> <p>Only 2/82 (2.4%) patients had satisfactory oxygen prescription specifying target saturation, device and initial flow rate before the intervention compared with 26/77 (34%) patients post‐intervention (χ<sup>2</sup> <italic>=</italic> 56.88, df <italic>=</italic> 5, <italic>P</italic> < 0.0001). Percentage of patients with conditions predisposing to hypercapnic respiratory failure who were overtreated with oxygen dropped from 9/19 (47%) to 4/22 (18%) following the study intervention (χ<sup>2</sup> <italic>=</italic> 4.011, df <italic>=</italic> 1, <italic>P</italic> <italic>=</italic> 0.04). Oxygen therapy monitoring was satisfactory during the audit period, but oxygen titration was unsatisfactory and did not significantly improve following the intervention.</p> </sec> <sec id="ajr12115-sec-0008" sec-type="section"> <title>Conclusions</title> <p>A multicomponent intervention can achieve a significantly increased rate of satisfactory oxygen prescriptions specifying target saturation, including in those who are at risk of hypercapnic respiratory failure.</p> </sec> </abstract>