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Oxygen therapy and prescription for paediatric inpatients <\/strong><\/span><\/p>\n Oxygen is regarded as a medicine and therefore cannot be administered by nursing staff without a prescription. This is a legal requirement<\/em><\/strong>.<\/p>\n <\/p>\n Background<\/strong> National Patient Safety Agency<\/strong><\/span> University Hospital of Wales<\/strong><\/span> Paediatric Addendum<\/strong><\/span><\/p>\n This document is produced by a multidisciplinary paediatric team involved in implementing parallel changes to oxygen therapy in paediatric inpatients at the University hospital of Wales. The majority of oxygen related incidents reported to the NPSA are likely to have occurred in adult patients with chronic disease, where excessive oxygen therapy can be dangerous as it may affect the patient\u2019s respiratory drive. This is less of an issue in paediatric patients. The adult BTS guidelines are not directly applicable to paediatric patients. Oxygen therapy in children<\/strong> Target oxygen saturations<\/strong>\n
\nBTS Guidelines – 2008<\/strong><\/span>
\nBTS guidelines for emergency oxygen use in adults indicate that oxygen for inpatients must be prescribed and monitoring of therapy must be formally documented. There are currently no parallel guidelines for the management of emergency oxygen therapy in children, but these are in the process of being developed.
\nThe adult guideline provides guidance on the following principles:<\/strong>
\n\u2022 Defining target oxygen saturations for different patient groups
\n\u2022 Prescribing oxygen
\n\u2022 Monitoring and altering oxygen therapy accordingly<\/p>\n
\nRapid Response Report \u2013 September 2009<\/em>
\nThe NPSA received 281 reports of serious incidents related to inappropriate administration and management of oxygen. Of these incidents, poor oxygen management appears to have caused nine patient deaths and may have contributed to a further 35 deaths.
\nCommon themes identified from the review of these incidents<\/strong>
\n\u2022 Prescribing: failure to or wrongly prescribed
\n\u2022 Monitoring: patients not monitored, abnormal oxygen saturation levels not acted upon
\n\u2022 Administration: confusion of oxygen with medical compressed air, incorrect flow rates, inadvertent
\n\u2022 Equipment: empty cylinders, faulty and missing equipment
\n\u2022 Disconnection of supply
\nNPSA recommendations for every institution<\/strong>
\n\u2022 NPSA briefing sheets highlighting actions to minimise risks of oxygen therapy are immediately made available to all relevant staff.
\n\u2022 The use of oxygen cylinders is minimised
\n\u2022 Where the use of oxygen cylinders is unavoidable robust systems are in place to ensure reliable and adequate supplies, including checking and stocktaking of cylinders.
\n\u2022 The risks of confusing oxygen and medical compressed air are assessed and action plans developed
\n\u2022 Oxygen is prescribed in all situations in accordance with BTS guidelines (but note these do not cover critical care or children less than 16 years).
\n\u2022 In an emergency, oxygen should always be given immediately and documented later.
\n\u2022 Pulse oximetry is available in all locations where oxygen is used.
\n\u2022 A multidisciplinary group responsible for reviewing oxygen-related incidents, developing a local oxygen policy and a training programme.<\/p>\n
\nUHW have implemented the following strategies to date
\n\u2022 Minimal oxygen cylinder use hospital wide.
\n\u2022 Governance strategies where use of oxygen cylinders is unavoidable hospital wide
\n\u2022 Education programme in adult services.
\n\u2022 Mandatory prescription of oxygen in adult services using drug chart sticker.
\n\u2022 Doctor and nurses training programme for effective prescription and monitoring of oxygen therapy in adult services.
\n\u2022 System of oxygen therapy governance for monitoring of oxygen related incidents.<\/p>\n
\nThis paediatric addendum has concentrated on implementing safe prescription, monitoring and titration of oxygen therapy in paediatric inpatients. It will need to be reviewed with reference to the BTS guidelines for the emergency management of oxygen therapy in children, when this document has been published.<\/p>\n
\nChildren are given oxygen in hospital in the following situations
\n\u2022 The majority of children admitted to hospital acutely who require oxygen have a lower respiratory infection or asthma.
\n\u2022 Systemically unwell children (e.g. DKA, sepsis, trauma) are given oxygen in the emergency situation as per APLS guidelines.
\n\u2022 Children with a chronic oxygen requirement including chronic lung disease of prematurity, pulmonary hypertension or end-stage cystic fibrosis are often admitted to hospital either routinely or when unwell. These patients will have a predefined range within which the oxygen saturations should be maintained.<\/p>\n
\nOxygen is delivered to children to achieve specific target oxygen saturations and these will differ depending on the indications for oxygen therapy.
\n\u2022 Oxygen saturations for healthy children with an intercurrent illness should be >92%.
\n\u2022 Oxygen saturations for children with chronic lung disease of prematurity should be between 91-94%.
\n\u2022 Oxygen saturations for children with or at risk of pulmonary hypertension should be >95%
\n\u2022 Children with congenital heart disease and blood mixing may have low oxygen saturations at baseline, and advice should be sought from the cardiology team with regard to target saturations in these patients.<\/p>\n