Implementation of a multicomponent intervention to optimise patient safety through improved oxygen prescription in a rural hospital

ObjectiveTo rationalise oxygen procedures in adult medical and surgical inpatients with a view to improving patient safety. DesignProspective pre- and post-intervention audit. SettingManning Hospital, a rural referral hospital in Taree NSW. ParticipantsPre-intervention: 82 patients aged 72.714.7 years. Post-intervention: 77 patients aged 73.612.4 years. InterventionA multicomponent intervention composed of implementation of a local hospital oxygen policy, introduction of a specific oxygen prescription chart and targeted staff education. Main outcome measuresSatisfactory oxygen prescription, monitoring and titration. ResultsOnly 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 ((2)=56.88, df=5, P<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 ((2)=4.011, df=1, P=0.04). Oxygen therapy monitoring was satisfactory during the audit period, but oxygen titration was unsatisfactory and did not significantly improve following the intervention. ConclusionsA 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.