P176 The changing face of home oxygen therapy; seamless communication between hospital, primary, and community care is essential. (12th November 2019) - Apps, MCP
Abstract : Introduction: Long term oxygen therapy for home use was introduced after trials which showed it worked in COPD and oxygen concentrator development. Some services are hospital based, but some patients too ill to attend; others community based often without full data on hospital blood gases and treatments in the primary care record. We have examined the primary care notes on all patients on our oxygen register to see why they are on it, and identify issues to improve care. Methods: We carried out audits on source/diagnosis for referral and examined primary care notes for all those on the oxygen register We have looked for issues that needed addressing for each patient. Results: We took over the service in April 2015; 109 patients receiving oxygen were alive 1.2.19. 59 with COPD, 7 on NIV, 42LTOT, 10 ambulatory oxygen alone. 19 with OHS/OSA, 6 ILD, 5 on LTOT, 1 ambulatory. Audits in 2018 (345) and 1.1.19–26.6.19 (202) show 56% of referrals with COPD, 12% ILD. Of 538 patients on the oxygen register, 322 COPD, of which 20 NIV, 38 ambulatory, 237 LTOT, 52OHS/OSA, 9 PAH, 18LVF, 26 palliative. 65 had PCO2>7, 19 on NIV/CPAP, 4 who refused it, 7 referred for NIV, 41/46COPD LTOT. Where ↑PCO2 (16), 2 sent to A&E, 2 referred NIV, 5 already on NIV, 1 refused NIV. Of 24 patients with ↓PCO2, 10/24 needed therapy change. 18 had delayed annual review, 9 patient issues, 9 service issues. Communication issues included incomplete blood gases from HOOF, hospital referral or sleep services, hospital unable to access primary care records, and the need to identify for early post discharge gases those with respiratory failure in hospital. Discussion: Home oxygen provision is not just for COPD, and NIV/CPAP patients are an increasing group. PCO2>7 should mean early review and consideration of NIV support. Although many patients with oxygen therapy have a short lifespan, some survive for years. Some patients can only be seen at home. Conclusion: Good communication is the key to delivery of oxygen services where increasing NIV/CPAP and a need for NIV support for chronic CO2 retainers is increasing.