Oxygen is one of the most commonly used, yet poorly prescribed drugs. The British Thoracic Society (BTS) 2015 National Oxygen Prescribing Audit highlighted national shortcomings in prescribing practices and use of oxygen. A 2017 audit at The Royal Sussex County Hospital amongst hospital inpatients continued to highlight inadequacies in the prescribing, monitoring and documentation of oxygen.

Aims 95% of patients using oxygen to have a valid drug chart prescription

100% of patients to have a target saturations range specified

100% of patients to have oxygen saturations documented with sufficient frequency for their NEWS score

90% of patients to have ‘actual’ SpO2 within their specified target range

Methods We carried out yearly re-audits in November 2018 and 2019 to objectively measure the impact of trust-wide and local changes.

PDSA Cycle 1

-Introduction of the ‘NEWS 2’ scale

-Re-designing drug charts with ‘tick-boxes’ for target oxygen saturations

PDSA Cycle 2

-Mandatory junior doctor teaching on safe oxygen prescribing

-‘Oxygen Safety’ posters on wards

-Reminders at handover for staff to measure and document oxygen saturations

Results Following PDSA Cycle 1, all patients with valid oxygen prescriptions had a specified target saturations range. In the PDSA Cycle 2 re-audit, all patients had ‘actual’ saturations within their prescribed target range, and 99% had oxygen saturations documented with sufficient frequency for their NEWS score. These were huge improvements from previous audits, which highlighted significant proportions of patients at risk of hypercapnia. Despite improvements, 14% of patients continued to use oxygen without valid prescriptions in 2019.

Conclusions Through a combination of trust-wide and local changes, we were able to drastically improve behaviours towards oxygen use. This will have great implications towards improving the safety and quality of care patients receive. Further work is needed to ensure oxygen is consistently prescribed.