Oxygen is recognised as a drug by the British National Formulary,¹ necessitating accurate prescribing to ensure patient safety. Poor oxygen prescribing practices have been observed within UK clinical settings, with previous reports of 40% of inpatient oxygen administration lacking appropriate prescriptions.² Inaccurate documentation of escalation plans around oxygen delivery during an acute event prompted oxygen prescribing being added to the local risk register. A multidisciplinary team was formed, who worked together with our electronic prescribing and health records (EPIC) analysts to configure a prescribable oxygen therapy prescription. This was launched on the respiratory wards. This audit aimed to evaluate the accuracy of oxygen prescriptions and assess the effectiveness of the new prescribing tool for our patients.

Data was collected using EPIC to review the patient‘s oxygen usage and cross-referenced with their prescription to ensure active oxygen therapy. The accuracy of prescribed oxygen therapy was verified with the patient‘s bedside nurse. Inconsistencies between the prescription and administration were reported to the prescriber for updates to maintain accurate medical records. Data collection occurred during medicines reconciliation for new admissions, while established patients‘ oxygen therapy prescriptions were reviewed three times a week from January to March 2023. The collected data was then analysed, focusing on identifying common themes related to prescription errors.

Results showed that initially, 50% of patients admitted on oxygen did not have a prescription, and 18% had an inaccurate prescription. Clinical reviews resulted in improvements, with subsequent prescriptions being accurate for 87% of patients. However, this improvement was also because many patients’ parameters did not change, during their admission, meaning their prescription remained accurate for the remainder of the audit. Common prescription errors included incorrect flow rate, lack of escalation plan documentation, and failure to prescribe oxygen therapy altogether. Recommendations were proposed to enhance oxygen prescription accuracy and patient safety.

We suggested to prescribe target saturations for all patients upon admission, following the British Thoracic Society adult guidelines. It is worth noting that there are no national recommendations for oxygen prescribing for paediatric patients in hospital. This could cause confusion and it would be difficult to identify which patients were receiving oxygen and which patients were not. Additionally, the current oxygen therapy prescription details more around the administration and flow rate of the oxygen therapy, which the target saturation prescribing does not cover. Therefore, this may not be a suitable implementation within a paediatric setting.

Secondly, we recommended that all patients on a non-invasive/invasive ventilator receiving oxygen should have a ventilator and an oxygen therapy prescription. While this involves duplication of work, the oxygen therapy prescription provides more detailed parameters for accurate oxygen administration. Improving oxygen prescription is crucial for patient safety and aligns with global initiatives, such as the World Health Organization‘s Medication Without Harm campaign. Accurate prescriptions ensure patients receive oxygen therapy at the appropriate parameters, promoting effective communication and continuity of care. By implementing these recommendations, hospitals can enhance the accuracy and safety of oxygen prescribing practices, ensuring optimal patient care.

References

1. NICE. Oxygen [Internet]. NICE. 2022 https://bnf.nice.org.uk/treatment-summaries/oxygen/ (Accessed March 2023).

2. O’Driscoll BR, Howard LS, Davison AG. BTS guideline for emergency oxygen use in adult patients. Thorax 2008;63:vi1–vi68.