Oxygen prescription and administration at the Emergency Department and medical wards in Mater Dei Hospital

Abstract

Aims: The aim of this study was to audit current practices on oxygen prescription in the Emergency Department (ED), and on accurate oxygen administration in the wards of Mater Dei Hospital. Method: Two hundred and forty eight adult patients attending the ED with diagnoses most likely to require oxygen therapy (mainly cardio-respiratory conditions) were randomly selected during 5 winter weeks. Data were collected on oxygen saturation, arterial blood gases, oxygen administration at the ED, oxygen prescription and its documentation, and oxygen administration in wards. The z-test was used to assess statistical significance of results and Fisher’s exact test was used to determine the effect of oxygen prescription documentation in treatment charts. Results: Oxygen treatment was indicated in 85 of the 248 patients. Of these, documented oxygen administration at the ED was only present in 23.5% (p<0.0001). Formal instructions on oxygen use were documented in 85.9% (p<0.0001), however in 51.8% of these there were incomplete details. Only 7.1% of patients in whom oxygen treatment was prescribed received oxygen therapy in the wards according to instructions (p<0.0001). It was also found that documenting oxygen prescription in treatment charts made no significant difference to the number of patients who actually received oxygen correctly in the ward. Conclusion: This study shows that there is need for better prescription, documentation and administration of oxygen in our hospital. Introduction of simple standardized oxygen charts may ensure that oxygen prescription and monitoring in the ED is carried out properly and that these instructions are then faithfully carried out in our wards.