PATIENT SAFETY ISSUE FOR
February 2015:
The prescription and Administration of Supplemental Oxygen
Situation
The administration of supplemental oxygen is an essential element of appropriate
management for a wide range of clinical conditions; however oxygen is a drug and
requires prescribing in all but emergency situations. The safe implementation of oxygen
therapy with appropriate monitoring and handling is an integral component of the
Healthcare Professional’s role and failure to administer oxygen appropriately can result
in serious harm to the patient.
Background
The purpose of this briefing is to provide guidance on the care of patients requiring
supplemental oxygen therapy and to ensure that oxygen is prescribed safely and
appropriately with appropriate monitoring and equipment in place.
Assessment
Responsibility for safe and effective oxygen administration lies with registered healthcare
professionals who in order to administer oxygen safely must understand:
• The indications for oxygen
• The hazards associated with oxygen therapy
• Oxygen and humidification systems in use
• Potential side effects of usage
• Safe storage of Oxygen
• How to transfer patients using oxygen safely
All patients who require oxygen should receive therapy that is appropriate to their clinical
condition and in line with national guidance (British Thoracic Society Guideline; Thorax,
2008).
Patients must be monitored throughout to ensure the oxygen delivered achieves the
target saturation range. This must be specified in addition to method.
Recommendations
Following admission any patient requiring oxygen therapy should be
doctor/ non-medical prescriber at the earliest opportunity (Note in
situation a prescription is not required. Oxygen should be given
immediately but documented retrospectively in the patient’s record
clinically acceptable.)
reviewed by a
an emergency
to the patient
as soon as is
How must oxygen be prescribed?
•
•
Using the Oxygen section of the All Wales Drug Administration Record, specify the
target saturation
Specify the mode of delivery and whether humidification is to be used
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•
Specify how often observations will be required
What can I do when administering oxygen?
All staff involved in the provision and administration of oxygen should be able to
demonstrate competency with the equipment in use within their clinical area of work.
Where cylinders are in use staff should understand the process for changing the flow
meters (usually undertaken by the Portering Team).
All equipment should be regularly checked and stocks of masks readily available and
accessible.
Because of the risks from poor oxygen management, staff administering oxygen should
ask:
• Am I aware of the patient’s diagnosis and target saturation?
• Does the flow rate need adjusting to achieve that patient’s target saturation?
• Am I familiar with the equipment to do this, and have I checked they are in working
order (e.g. face mask/nasal cannulae)?
• Have I recorded the oximetry results (saturation levels)?
• Is the tube connected to the right outlet i.e. oxygen not air?
While piped oxygen will be the main source of supply, the use of cylinders should be
kept to a minimum. Where the use of oxygen cylinders is unavoidable systems should be
in place to ensure that supplies are readily available, accessible and checked on a
regular basis (e.g. during intentional rounding) when in use. In addition there needs to be
clear segregation of full and empty cylinder supplies.
When using cylinders you should:
• Ensure that you know how to safely use cylinders and are familiar with the BOC
Medical Oxygen cylinder guidance leaflet.
• Ensure all Anti Tamper plastic seals are removed prior to use
• Ensure that the delivery tube is connected to the cylinder
• Check the amount of oxygen in the cylinder before use and ensure there is enough
oxygen in the cylinder to last as long as required
• Ensure that the cylinder is turned on and is delivering oxygen to the patient
• Replace empty or near-empty cylinders immediately
• Place the cylinder in an appropriately designed holder – avoid placing the cylinder on
the bed
• Ensure that when patients are transferred between areas that there is clear
documentation of their ongoing oxygen therapy and that they are accompanied by a
trained member of staff wherever possible.
It is important that patients are warned not to smoke when they use oxygen and
that they never allow any other person to smoke in their vicinity as there is a risk
of facial burns and fire or explosion.
Adrian Thomas – Assistant Director of Therapies and Health Sciences
Dr Brian Tehan – AMD Patient Safety
Prof Matthew Makin – Medical Director
Mrs Angela Hopkins – Director of Nursing and Midwifery
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