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Anderson J, Hoang T, Hay K, Tay G. Evaluation of inpatient oxygen therapy in hypercapnic chronic obstructive pulmonary disease. Intern Med J 2021; 51:654-659. [DOI: 10.1111/imj.15070] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/10/2020] [Accepted: 09/14/2020] [Indexed: 11/26/2022]
Affiliation(s)
- James Anderson
- Respiratory Department Sunshine Coast University Hospital Sunshine Coast Queensland Australia
- University of Queensland Brisbane Queensland Australia
| | - Tiffany Hoang
- Respiratory Department Sunshine Coast University Hospital Sunshine Coast Queensland Australia
| | - Karen Hay
- QIMR Berghofer Medical Research Institute Brisbane Queensland Australia
| | - George Tay
- University of Queensland Brisbane Queensland Australia
- QIMR Berghofer Medical Research Institute Brisbane Queensland Australia
- Thoracic Medicine The Prince Charles Hospital Brisbane Queensland Australia
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2
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Choudhury A, Young G, Reyad B, Shah N, Rahman R. Can we improve the prescribing and delivery of oxygen on a respiratory ward in accordance with new British Thoracic Society oxygen guidelines? BMJ Open Qual 2018; 7:e000371. [PMID: 30397658 PMCID: PMC6203005 DOI: 10.1136/bmjoq-2018-000371] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 06/07/2018] [Accepted: 09/16/2018] [Indexed: 11/03/2022] Open
Abstract
The British Thoracic Society recommends oxygen delivery to achieve target oxygen saturation range between 94% and 98% for medically unwell adult patients, and 88% to 92% in patients at risk of hypercapnic respiratory failure. Interviews with our medical and nursing staff suggested that oxygen was sometimes being given to patients without a valid order and there was a failure to titrate oxygen to the stated oxygen saturation range. Our aim was to improve appropriate oxygen delivery to 90% of our patients on a 30-bedded respiratory ward within 3 months. We identified several key steps to safe oxygen delivery on our ward. These include the recording of target oxygen saturation range, the prescribing of an oxygen order on drug chart and the correct bedside delivery of oxygen to the patient. To help improve compliance of these key steps, the following plan-do-study-act (PDSA) interventions were undertaken: (1) Educational announcements at board rounds. (2) A communication oxygen poster. (3) Highlighting improvement progress to teams via email. (4) Pharmacist review of inpatient drug chart. (5) Display of target oxygen saturation range at patient bedside. At baseline, only 50% of drug charts had a recorded oxygen order and 60% of drug charts had a set target oxygen saturation range. Following PDSA interventions, both measures improved to 93%. Our main outcome measure of appropriate oxygen delivery to the patient improved from a baseline of 20% to 80% on completion. Our quality improvement programme has shown simple interventions can improve oxygen prescribing and appropriate delivery of oxygen to the patient. The most effective PDSA interventions were sharing our measurements via email and displaying target oxygen saturation ranges by the patient bedside. We aim to provide future oxygen educational sessions at induction to our staff and scale our quality improvement programme to other wards including our acute medical unit.
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Affiliation(s)
- Aklak Choudhury
- Department of Respiratory Medicine, Barking, Havering and Redbridge University Hospitals NHS Trust, Queen’s Hospital, Romford, UK
| | - Gregor Young
- Department of Respiratory Medicine, Barking, Havering and Redbridge University Hospitals NHS Trust, Queen’s Hospital, Romford, UK
| | - Beshoy Reyad
- Department of Respiratory Medicine, Barking, Havering and Redbridge University Hospitals NHS Trust, Queen’s Hospital, Romford, UK
| | - Nirali Shah
- Department of Respiratory Medicine, Barking, Havering and Redbridge University Hospitals NHS Trust, Queen’s Hospital, Romford, UK
| | - Radhea Rahman
- Department of Respiratory Medicine, Barking, Havering and Redbridge University Hospitals NHS Trust, Queen’s Hospital, Romford, UK
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Wen Z, Chen J, Bian L, Xie A, Peng M, Li M, Wei L. The nasal oxygen practice in intensive care units in China: A multi-centered survey. PLoS One 2018; 13:e0203332. [PMID: 30161225 PMCID: PMC6117075 DOI: 10.1371/journal.pone.0203332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 08/17/2018] [Indexed: 01/09/2023] Open
Abstract
Background Nurses frequently administer nasal oxygen therapy for patients in intensive care units (ICUs). However, little is known about the current status, nurses’ management and perception on the nasal oxygen therapy in China. Therefore, we aimed to investigate the nasal oxygen practice of ICUs in China to provide insights into future direction. Methods A cross-sectional survey on 10 hospitals was conducted. A self-designed questionnaire was administered to ICU nurses. Descriptive statistics, univariate, and multiple stepwise regression analyses were performed to analyze the respondents’ questionnaires. Results A total of 580 respondents with a response rate of 96.67% were included in this study. The average correct answer rate was 58.28%. The current status of nasal oxygen administration in ICUs in Chinese hospitals lagged behind the recommendations of related guidelines. Nurses in China were eager to learn about the updated knowledge on oxygen therapy. The gender, age, clinical experience, degree, job title, and classification of working hospitals were not related to the oxygen therapy-related knowledge scores (all P>0.05). Conclusion Many deficiencies are observed regarding the nasal oxygen practice in ICUs of Chinese hospitals. Increased efforts by authorities and medical staff are required to narrow the gap between the current status of oxygen practice and the recommendations from related guidelines.
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Affiliation(s)
- Zunjia Wen
- SICU, Children’s Hospital of Nanjing Medical University, Nanjing, China
- Nursing Department, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Junyu Chen
- SICU, Children’s Hospital of Nanjing Medical University, Nanjing, China
- Nursing Department, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Lanzheng Bian
- Nursing Department, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Ailing Xie
- Nursing Department, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Mingqi Peng
- Nursing Department, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Mei Li
- Nursing Department, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Li Wei
- SICU, Children’s Hospital of Nanjing Medical University, Nanjing, China
- * E-mail:
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Cousins JL, Wark PAB, McDonald VM. Acute oxygen therapy: a review of prescribing and delivery practices. Int J Chron Obstruct Pulmon Dis 2016; 11:1067-75. [PMID: 27307722 PMCID: PMC4888716 DOI: 10.2147/copd.s103607] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Oxygen is a commonly used drug in the clinical setting and like other drugs its use must be considered carefully. This is particularly true for those patients who are at risk of type II respiratory failure in whom the risk of hypercapnia is well established. In recent times, several international bodies have advocated for the prescription of oxygen therapy in an attempt to reduce this risk in vulnerable patient groups. Despite this guidance, published data have demonstrated that there has been poor uptake of these recommendations. Multiple interventions have been tested to improve concordance, and while some of these interventions show promise, the sustainability of these interventions are less convincing. In this review, we summarize data that have been published on the prevalence of oxygen prescription and the accurate and appropriate administration of this drug therapy. We also identify strategies that have shown promise in facilitating changes to oxygen prescription and delivery practice. There is a clear need to investigate the barriers, facilitators, and attitudes of clinicians in relation to the prescription of oxygen therapy in acute care. Interventions based on these findings then need to be designed and tested to facilitate the application of evidence-based guidelines to support sustained changes in practice, and ultimately improve patient care.
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Affiliation(s)
- Joyce L Cousins
- Faculty of Arts, Nursing and Theology, Avondale College of Higher Education, Sydney, Australia; School of Nursing and Midwifery, John Hunter Hospital, Newcastle, NSW, Australia; Priority Research Centre for Healthy Lungs, John Hunter Hospital, Newcastle, NSW, Australia
| | - Peter A B Wark
- Priority Research Centre for Healthy Lungs, John Hunter Hospital, Newcastle, NSW, Australia; School of Medicine and Public Health, The University of Newcastle, John Hunter Hospital, Newcastle, NSW, Australia; Department of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, Newcastle, NSW, Australia
| | - Vanessa M McDonald
- School of Nursing and Midwifery, John Hunter Hospital, Newcastle, NSW, Australia; Priority Research Centre for Healthy Lungs, John Hunter Hospital, Newcastle, NSW, Australia; School of Medicine and Public Health, The University of Newcastle, John Hunter Hospital, Newcastle, NSW, Australia; Department of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, Newcastle, NSW, Australia
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Myers H, Taylor J, Finn RS, Beckert L. Doctors learn new tricks, but do they remember them? Lack of effect of an educational intervention in improving
O
xygen prescribing. Respirology 2015; 20:1229-32. [DOI: 10.1111/resp.12614] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 05/31/2015] [Accepted: 06/20/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Hamish Myers
- Respiratory Medicine Canterbury District Health Board Christchurch New Zealand
| | - Julia Taylor
- Respiratory Medicine Canterbury District Health Board Christchurch New Zealand
| | - Rhian S. Finn
- Respiratory Medicine Canterbury District Health Board Christchurch New Zealand
| | - Lutz Beckert
- Respiratory Medicine Canterbury District Health Board Christchurch New Zealand
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6
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Howden R, Cooley I, Van Dodewaard C, Arthur S, Cividanes S, Leamy L, McCann Hartzell K, Gladwell W, Martin J, Scott G, Ray M, Mishina Y. Cardiac responses to 24 hrs hyperoxia in Bmp2 and Bmp4 heterozygous mice. Inhal Toxicol 2013; 25:509-16. [PMID: 23876042 PMCID: PMC6149216 DOI: 10.3109/08958378.2013.808287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Hyperoxia or clinical oxygen (O2) therapy is known to result in increased oxidative burden. Therefore, understanding susceptibility to hyperoxia exposure is clinically important. Bone morphogenetic proteins (BMPs) 2 and 4 are involved in cardiac development and may influence responses to hyperoxia. METHODS Bmp2(+/)(-). Bmp4(+/)(-) and wild-type mice were exposed to hyperoxia (100% O2) for 24 hrs. Electrocardiograms (ECG) were recorded before and during exposure by radio-telemetry. RESULTS At baseline, a significantly higher low frequency (LF) and total power (TP) heart rate variability (HRV) were found in Bmp2(+/)(-) mice only (p < 0.05). Twenty-four hours hyperoxia-induced strain-independent reductions in heart rate, QTcB and ST-interval and increases in QRS, LF HRV and standard deviation of RR-intervals were observed. In Bmp4(+/)(-) mice only, increased PR-interval (PR-I) (24 hrs), P-wave duration (P-d; 18 and 21-24 hrs), PR-I minus P-d (PR - Pd; 24 hrs) and root of the mean squared differences of successive RR-intervals (24 hrs) were found during hyperoxia (p < 0.05). DISCUSSION Elevated baseline LF and TP HRV in Bmp2(+/)(-) mice suggests an altered autonomic nervous system regulation of cardiac function in these mice. However, this was not related to strain specific differences in responses to 24 hrs hyperoxia. During hyperoxia, Bmp4(+/-) mice were the most susceptible in terms of atrioventricular conduction changes and risk of atrial fibrillation, which may have important implications for patients treated with O2 who also harbor Bmp4 mutations. This study demonstrates significant ECG and HRV responses to 24 hrs hyperoxia in mice, which highlights the need to further work on the genetic mechanisms associated with cardiac susceptibility to hyperoxia.
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Affiliation(s)
- R Howden
- Laboratory of Systems Physiology, Department of Kinesiology, University of North Carolina at Charlotte, Charlotte NC 28223, USA.
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Consequences of hyperoxia and the toxicity of oxygen in the lung. Nurs Res Pract 2011; 2011:260482. [PMID: 21994818 PMCID: PMC3169834 DOI: 10.1155/2011/260482] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 03/29/2011] [Accepted: 04/04/2011] [Indexed: 11/18/2022] Open
Abstract
Oxygen (O(2)) is life essential but as a drug has a maximum positive biological benefit and accompanying toxicity effects. Oxygen is therapeutic for treatment of hypoxemia and hypoxia associated with many pathological processes. Pathophysiological processes are associated with increased levels of hyperoxia-induced reactive O(2) species (ROS) which may readily react with surrounding biological tissues, damaging lipids, proteins, and nucleic acids. Protective antioxidant defenses can become overwhelmed with ROS leading to oxidative stress. Activated alveolar capillary endothelium is characterized by increased adhesiveness causing accumulation of cell populations such as neutrophils, which are a source of ROS. Increased levels of ROS cause hyperpermeability, coagulopathy, and collagen deposition as well as other irreversible changes occurring within the alveolar space. In hyperoxia, multiple signaling pathways determine the pulmonary cellular response: apoptosis, necrosis, or repair. Understanding the effects of O(2) administration is important to prevent inadvertent alveolar damage caused by hyperoxia in patients requiring supplemental oxygenation.
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Powrie K, Smith SM. Editorial: Emergency Oxygen for Adults guideline - a change in oxygen therapy practice? J Clin Nurs 2010; 19:601-2. [DOI: 10.1111/j.1365-2702.2009.02929.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Medford A, Bowen J, Harvey J. Improved oxygen prescribing using a nurse-facilitated reminder. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2009; 18:730-4. [PMID: 19543159 DOI: 10.12968/bjon.2009.18.12.42886] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Poor oxygen prescribing and administration is well documented despite junior doctor education and oxygen prescription charts. This prescribing behaviour can be harmful to patients. This study examines whether oxygen prescribing and the appropriateness of oxygen therapy would be increased by medical admissions unit (MAU) nurse education and a nurse-mediated reminder strategy to junior medical staff. A quality improvement study was carried out involving a prospective single centre audit, educational intervention to MAU nurses, and implementation of a nurse-facilitated oxygen prescribing reminder strategy with prospective re-audit. The study took place in a 26-bed MAU in a 678-bed teaching hospital with a lung centre serving a population of 540,000. Fifty-one patients were involved in the initial and re-audits and two nurses were involved in the audit team. A team of 10 acute medical nurses were involved in facilitating the appropriate administration and prescription of oxygen by liaison with junior medical staff. Oxygen prescription and appropriateness of oxygen therapy were measured. Results showed an improvement in oxygen prescribing from 0% to 49% (p < 0.0001). Non-significant improvements in appropriate oxygen prescription (pre- versus post-intervention) overall (70.6% versus 76.5%, p = 0.65); more marked reduction in type 1 respiratory failure errors (18.4% versus 3.8%, p = 0.13) and less marked reduction in type 2 respiratory failure errors (61.3% versus 44.0%, p = 0.49). In conclusion, significant and quick improvements in oxygen prescribing behaviour are achievable through a nurse-facilitated reminder strategy with reduction in inappropriate oxygen prescribing. These strategies are relevant to other ward settings and aspects of patient care.
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Affiliation(s)
- Andrew Medford
- Department of Respiratory Medicine, Glenfield Hosptial, Leicester
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O'Driscoll R. A breath of fresh air: a new UK guideline for emergency oxygen therapy. Br J Hosp Med (Lond) 2009; 69:670-1. [PMID: 19186603 DOI: 10.12968/hmed.2008.69.12.670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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