Background During the COVID-19 pandemic, health services across the globe have been under strain ensuring they have the capacity to deal with the substantially increased proportion of patients requiring supplemental oxygen. The NEWS2 scoring system has a target oxygen saturation of ≥96% (88-92% in patients with hypercapnia). However, British Thoracic Society (BTS) Guidelines recommend targets of 94-98%.

Aim To conserve oxygen supplies during the pandemic without compromising patient safety, and, show the benefits of junior doctor engagement in healthcare leadership to service delivery.

Methods A retrospective analysis of oxygen usage in a 32 bedded acute medical unit was conducted. 783 admissions owing to 1768 clinical encounters were analysed for oxygen usage. Patients were deemed suitable for weaning if their oxygen saturation was ≥ 2% above the lower limit of the BTS recommended target.

Results 22.5% of patients receiving oxygen were suitable for oxygen weaning. Only 25.6% of these patients did so. 48.7% were suitable for weaning with BTS guidelines. If all eligible patients had been weaned following NEWS2 parameters, net savings of between 6 and 13% were achievable. Following BTS guidelines, net savings of between 16 and 33% could have been made (corresponding to over 3 million litres of oxygen on one ward annually). A new ‘Oxygen Weaning Guideline’ was created to help conserve vital oxygen supplies.

Conclusion Excessive oxygen is commonly supplied to patients. Whilst junior doctors may not have the ‘positional power’ to enact change as described by French and Raven, they are an important resource who can use a lens of opportunity to develop ‘informational power’ through novel audits to enact change. Lessons learned from this study have the potential to change clinical behaviours such that we are more efficient and sustainable with the administration of oxygen whilst alleviating the extra burden on oxygen delivery systems in health care systems worldwide.