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The British Thoracic Society has published a New Quality Standard for home oxygen use in adults
All patients who are being considered for long-term oxygen treatment (LTOT) at home should have a thorough risk assessment delivered by trained staff, according to new national standards.
The assessment should include a review of the risk of fire, trips and falls from using oxygen within the home. As part of the process, the smoking status of patients and other household members should be recorded – with safety advice and smoking cessation support supplied as appropriate.
The British Thoracic Society (BTS) is encouraging widespread use of its new set of Quality Standards for Home Oxygen Use in Adults by NHS commissioners, healthcare practitioners and patients to ensure the best possible clinical care.
The Standards also advise that all patients receive:
- a blood gas ‘check-up’ three months after the initiation of therapy, to assess the effectiveness, and future need, of LTOT at home;
- regular ongoing checks by a home oxygen assessment service, at least on an annual basis;
- education and information supplied by a specialist team.
The BTS Quality Standards for Home Oxygen Use in Adults, taken from the BTS Guideline on Home Oxygen Use in Adults (2015) offer ten quality statements summarising the latest, evidence-based practice available. They are endorsed by the Association for Respiratory Technology and Physiology (ARTP), the Association of Respiratory Nurse Specialists (ARNS), the Association for Chartered Physiotherapists in Respiratory Care (ACPRC), the Association of Palliative Medicine (APM) and the Primary Care Respiratory Society UK (PCRS-UK).
Home oxygen therapy involves breathing in air that contains more oxygen than normal from a cylinder or machine at home. It is typically prescribed for patients with heart or lung conditions who continue to have low blood oxygen levels after all other medical treatments have been given.
Latest figures show that around 85,000 people in England have oxygen at home.
Dr Jay Suntharalingam, Co-chair of the BTS Home Oxygen Quality Standard Development Group, commented:
“We’re delighted that the BTS quality standards for home oxygen use in adults are now available so that healthcare professionals can make decisions based on latest available evidence and best practice. It also gives greater clarity for people with respiratory disease, and their families and carers, on what services they should expect.
“Home oxygen can be a highly effective treatment for common lung conditions, including chronic obstructive pulmonary disease (COPD), when blood oxygen levels are low. This allows those affected to enjoy a better quality of life and can potentially improve life expectancy.
“However, as with all specialist treatments, it is vital that home oxygen is administered and reviewed effectively to ensure the safety and best health outcome for patients. The new quality standards provide an outstanding framework for achieving this.”
Wendy Preston, Chair of ARNS commented
“ARNS welcomes and has endorsed the publication of the BTS Home Oxygen Quality Standards and our members were represented on the development committee by Joe Annandale, Respiratory Nurse Specialist at Prince Philip Hospital, Wales.
Approximately 85,000 people are prescribed oxygen at home in England and it is essential that these ten quality standards are implemented. This will require services to be commissioned and funded appropriately which will include respiratory nurse specialists who often leaders of home oxygen assessment services.
Many thanks to Joe for leading on this valuable work on behalf of ARNS”
ARNS members took part in a BTS respiratory nurse survey in 2016, many thanks for your contribution.
The study, published in BMJ Open Respiratory Research (http://bmjopenrespres.bmj.com/content/4/1/e000210), analysed over 600 responses to two different online surveys – one for individual respiratory nurses and the other for NHS employers.
It was commissioned to map out the current state of the respiratory nurse specialty in the NHS, to help inform future workforce plans and ensure the long-term provision of quality patient care.
Key findings include:
- Only 5 in 10 nurses (53.6%) reported they were able to spend as much time with their patients as needed – and over a quarter (25.3%) felt they were unable to have sufficient patient contact.
- More than 9 in 10 nurses (91%) reported working additional hours each week above what was contracted, with nearly three quarters (72%) stating they worked an extra six hours a week.
- Within the next decade, 48.1% of nurses surveyed plan to, or will be eligible for, retirement – and a further 1.8% plan to leave nursing in the next five years. Retiring nurses are often working at a senior level and leading services, which raises a significant need to identify suitably qualified staff to replace them.
- A good proportion of nurses felt supported by clinical colleagues (77.6%) and line managers (62.2%) – the vast majority (93.1%) felt able to attend meetings and study days, with 78% agreeing that training and education opportunities were available to access.
Wendy Preston (Chair of ARNS) highlights that with close to half of all respiratory nurses planning to retire within the next ten years succession planning is essential and must be a priority. Many current respiratory nurses will have developed into their roles and often set up services within their clinical area. The jump to being a specialist or advanced nurse is vast and needs not only education resources to bridge but also time for supervised practice. There is a need for trainee roles and robust work force planning.
Read the response from Wendy Preston, Chair of ARNS, following publication by the Department of Health Tobacco Control Plan for England
‘We welcome the publication of the Tobacco Control Plan and had been campaigning as part of the Smoke-Free Alliance for the government to speed up its publication, as there had been a long period without a plan.
Whilst it’s aspirations are to be celebrated and there are clear targets, it is still unclear regarding the detail of how these will be met and there is missing substance around funding. Local authority funding for public health is consistently being cut and a report published by ASH in November 2016 showed that 59% had reduced or even in some cases stopped smoking cessation service. Whilst we know that smoking tobacco kills half of its users and has significant health burden, reducing access to essential smoking cessation treatment is not acceptable.’
Download the Department of Health Tobacco Control Plan for England here
At the ARNS 20th Anniversary Conference last month, delegates were invited to complete a questionnaire on COPD and Malnutrition. The results of the questionnaire are shown below:
Thank you for taking the time to complete the questionnaire at the ARNS 2017 Conference in Loughborough. We had 47 responses in total.
Just over half of respondents (52%) said that they carry out a nutritional assessment at every visit with 42 % only doing assessments if they had concerns. BMI is still the most common recorded assessment being used by 75% of HCP to assess Nutritional status with 59 % completing a full MUST score.
See full results of the questionnaire here COPD and Malnutrition Questionnaire Results from ARNS conference 2017 (002)
Nutricia is holding a study day on 24th Jully 2017 at Nutiricia offices in Chiswick Park, focusing on the ffects of malnutrition. If you would like to attend please contact Jo Lessells emial: Joanne.firstname.lastname@example.org or call her on 07500 577889
Education for Health is celebrating 30 years of improving the lives of people with long term conditions.
The education charity will mark this important milestone by sharing the stories of 30 people involved in its success on its website and social media channels – one each day in June.
It is also offering healthcare professionals the opportunity to apply for 30th anniversary bursaries and attend a number of its workshops for just £30
Chief Executive, Monica Fletcher OBE, said thanks to the ambition, passion and hard work of its staff, Trainers, Trustees and partners that the charity has grown from humble beginnings into a highly respected leader in providing education for health care professionals.
“It’s time to celebrate, to thank those who have contributed to our success, reflect on our achievements and make ambitious plans for the future,” she said.
“Over the years we have empowered many thousands of health care professionals, not just in the UK but around the world, to improve the lives of their patients. This is something we are immensely proud of.
“And while we have grown and evolved significantly over the past 30 years we have remained true to our founder’s vision, which is that we exist to improve the lives of people with long term conditions.”
Greta Barnes MBE founded the Asthma Training Centre in Stratford-upon-Avon in 1987 as she was aware that too many patients with asthma in the community (and secondary care) were being seen in an emergency, and sometimes life threatening, situation.
She believed route to improved management lay in organised preventive care, personally tailored treatment and the giving of practical advice as well as regular follow up and review.
In the early days students attended a three-day course in Stratford-upon-Avon and were awarded the Diploma in Asthma Care. Within two years of being set up a regional training network had been established to cope with demand.
Today Education for Health delivers education and training across a wide range of long term conditions including respiratory disease, cardiovascular disease and diabetes. In 2016 it educated more than 4,800 individuals and ran 340 courses ranging from workshops to level 5, 6 and 7 modules. The charity also delivers bespoke training to meet the specific needs of commissioners in
the NHS and other organisations, and provides a number of free-to-access online resources. Advocacy, influencing and research activities are an integral part of Education for Health’s activities. All of the charity’s education leads and trainers are practising clinicians who sit on a wide range of specialist networks, advisory boards, voluntary, NHS and professional bodies, and guideline development groups.
Education for Health believes in taking a collaborative approach and works with many partners in industry, the NHS and other charities.
Monica explained: “We work hard to raise awareness of the importance of an educated workforce and impart our knowledge and expertise to influence key reports, policies and guidelines.
“By doing so we are able to share our knowledge more widely to contribute to the body of science in long term conditions, a key area of activity for us and one we are very proud of.”
As for the next 30 years, Education for Health has ambitious plans for the future. “The charity’s role in helping to create a well informed and well-educated workforce will be
more important than ever and we will explore new ways of working to have a positive impact on the lives of even more people with long term conditions,” explained Monica.
“Above all, we will remained focussed on improving the lives of many more patients and doing the best we can to empower, encourage and support with long term conditions to look after themselves, manage their conditions and navigate health services.”
Find out more about Education for Health at www.educationforhealth.org or find the charity
on facebook and twitter @EdforHealth
Health professionals from across the NHS and beyond are being urged to adopt the latest version of the world’s first evidence-based guideline on the use of emergency oxygen, published today (Monday 15 May).
The updated guidance is based on new evidence about how effective prescribing and delivery of emergency oxygen for patients can both improve health and save lives.
The updated British Thoracic Society (BTS) Guideline for Oxygen Use in Adults in Healthcare and Emergency Settings, first published in 2008 and endorsed by over 20 clinical societies and colleges, advises health practitioners when prescribing oxygen to always specify a safe ‘target range’ of oxygen in the blood, which can then be monitored. This vital action is designed to ensure that patients are not given too little, or too much, oxygen which can result in greater illness and, in rare cases, even death.
The rationale for giving emergency oxygen treatment is to treat low blood oxygen levels (hypoxaemia) where the body’s cells are starved of oxygen, which can cause damage to vital organs which can lead to death. Oxygen can be used to help treat a number of lung diseases, such as pneumonia or deteriorations in asthma or chronic obstructive pulmonary disease (COPD). Oxygen is also used with other diseases such as heart failure and sepsis, which do not directly involve the lungs.
The updated Guideline now covers:
- Emergency oxygen use, and most other oxygen use, in healthcare settings
- Short-term oxygen use by healthcare workers outside of healthcare settings
The new areas included are:
- Endoscopy (for example, gastroscopy) and other procedures requiring sedation
- Care before, during and after operations including patient-controlled analgesia
- Palliative care settings like hospices
- Use of oxygen mixtures, like Entonox (‘gas and air’) – widely used in childbirth
- Use of high-flow humidified nasal cannulae (a relatively new method for oxygen delivery)
- Use of oxygen by healthcare professionals in patients’ homes
- Use of oxygen by voluntary rescue organisations and other non-NHS first responders
Evidence of the Guideline’s effectiveness has been increasing since it was first launched in 2008.
Among a number of studies in support of its impact, one randomised controlled trial and two observational studies have supported decades of evidence that giving high concentration oxygen to patients with severe exacerbations of COPD can increase the likelihood of death, often associated with critically high levels of carbon dioxide in the blood. These studies support the case for the BTS Guideline’s recommendation of a lower safe ‘target range’ of 88-92% oxygen saturation for patients with COPD.
Another example of evidence spotlights the issue of patients with heart attacks with normal blood oxygen levels being given high concentration oxygen – this was common practice until very recently but probably increases the size of the heart attack due to constriction of the blood vessels in the heart in response to high doses of oxygen. There is also mounting evidence which indicates that very high blood oxygen levels in intensive care unit (ICU) patients are also associated with increased death rates. These recent studies support the effectiveness of the BTS Guideline-recommended ‘target range’ for improving patient outcomes.
Dr Ronan O’Driscoll, Consultant Respiratory Specialist at Salford Royal NHS Foundation Trust, and first author of the British Thoracic Society’s Guideline for Oxygen Use in Adults in Healthcare and Emergency Settings, said:
“Oxygen is a very important drug and should always be prescribed and monitored like any other medication. It is very beneficial to many patients, but can be harmful if misused.
We urge all clinicians to adopt the updated BTS Guideline so that emergency oxygen is always used in an optimal and safe way.
We’re delighted that a new body of evidence is confirming how effective following the Guideline can be in improving patient outcomes and reducing avoidable deaths.
The Guideline has now been extended to include more uses of oxygen ranging from procedures requiring sedation such as endoscopy, through to use of oxygen mixtures like ‘gas and air’ widely used in childbirth, to benefit an even greater number of patients.”
1 in 7 patients in UK hospitals receives oxygen therapy for their condition on any given day, according to the BTS Emergency Oxygen Audit report (2015). Yet more than 4 in 10 of these patients (about 6,000 on an average day) are receiving oxygen with no prescription or other written order to help ensure that staff deliver and monitor oxygen use safely and effectively. Furthermore, over half of hospitals don’t provide sufficient training in oxygen provision and monitoring for doctors or nurses.
However, the 2015 audit also reflected some real progress in the UK:
- 85% of hospitals have implemented an oxygen policy
- 100% used pulse oximeters to measure a patient’s oxygen levels on all nursing observation rounds
- 72% recorded the patient’s oxygen levels in a dedicated oxygen section on the monitoring chart consistent with the BTS oxygen guidelines
BTS won a National Patient Safety Award in 2011 for its campaigning work in the area of safe oxygen use, which has included the delivery of Guidelines, educational resources and audit to help hospitals provide oxygen safely and effectively.
The BTS Guideline for Oxygen Use in Adults in Healthcare and Emergency Settings can be downloaded here: https://www.brit-thoracic.org.uk/standards-of-care/guidelines/bts-guideline-for-emergency-oxygen-use-in-adult-patients/
The BTS Guideline for oxygen use in adults in healthcare and emergency settings has been endorsed by: Association of British Neurologists, Association of Chartered Physiotherapists in Respiratory Care, Association for Palliative Medicine, Association of Respiratory Nurse Specialists, Association for Respiratory Technology and Physiology, British Association of Stroke Physicians, British Geriatrics Society, College of Paramedics, Intensive Care Society, Joint Royal Colleges Ambulance Liaison, Primary Care Respiratory Society UK, Resuscitation Council (UK), Royal College of Anaesthetists, The Royal College of Emergency Medicine, Royal College of General Practitioners, Royal College of Nursing (endorsement granted until April 2020), Royal College of Obstetricians and Gynaecologists, Royal College of Physicians London, Royal College of Physicians of Edinburgh, Royal College of Physicians and Surgeons of Glasgow, Royal Pharmaceutical Society and The Society for Acute Medicine.