Home oxygen – A guide for health professionals in Lambeth,
Southwark & Kings Health Partners
Principles of oxygen therapy
Oxygen is a medication and is best prescribed and administered by experienced health
professionals who have received specific training. Oxygen is used to alleviate hypoxaemia and
available evidence suggests that oxygen does not relieve breathlessness in the absence of
hypoxaemia – this includes palliative care cases.
Hypoxaemia is diagnosed by arterial blood gas measurement taken after 30 minutes of
breathing room air and is defined as: PaO2 <7.3kPa or PaO2 <8.0kPa when secondary
polycythaemia or pulmonary hypertension is present.
Pulsoximetry is a useful tool for screening and monitoring hypoxaemia. Oxygen saturations
consistently <92% in stable disease suggest chronic hypoxaemia and referral for assessment
should be considered and offered. If you have a patient with disabling breathlessness and
saturations consistently >92% then consider referral to an appropriate specialist to ensure
optimal therapy or palliative care review to consider other treatments for breathlessness.
Inappropriate supply and prescription of oxygen may cause harm, distress and discomfort to
patients, as well as a potential decline in functional ability. Too much oxygen may cause
1,000-3,000 avoidable UK deaths per year during chronic obstructive pulmonary disease
exacerbations.
Assessing a patient for oxygen when they or their household smoke is an opportunity to
provide stop smoking treatments. Safety checks and risk assessments will be organised by the
HOSAR team and oxygen provider.
Types of oxygen therapy
Long-term oxygen therapy (LTOT) corrects chronic hypoxaemia and it can prolong life in COPD if
used for at least 15 hours each day. It is for use at rest and is usually delivered by a machine that
concentrates the oxygen component of room air. It is quite safe to come off LTOT for short periods
during the day.
Ambulatory oxygen therapy allows people to exert themselves beyond what their underlying
condition would otherwise allow them to do because of hypoxaemia and in doing so can maintain or
increase their functional status and quality of life. They are often not hypoxic at rest, so consider
referring for this therapy if there is evidence of falling oxygen saturations when mobile more than a
few metres outdoors.
Short burst oxygen therapy provides no clinical benefit to breathless people and should only be
ordered in specialist circumstances such as neurologist & GPSI diagnosed cluster headache.
HOSAR – The home oxygen
assessment and review service
The HOSAR team is an integral part
of the Lambeth, Southwark and
KHP respiratory pathway. The
service supports colleagues in
hospital, community and primary
care who have adult patients
needing assessment or review of
oxygen therapy. New orders are
reviewed at 6 weeks and then
annually
GP and community oxygen assessment
or review - Oxygen assessments
originating in the community will in
general be non-urgent. Access to the
HOSAR team is via the respiratory single
point of referral system in each
borough.
If you feel the assessment is genuinely
urgent, GPs can order using a HOOF A
from: click here
http://www.pcc-cic.org.uk/article/home-oxygen-order-form
These orders are temporary so please
also make a referral to the HOSAR
team when doing a HOOF A.
GSTT community staff, including the
specialist palliative care team, can refer
internally to the GSTT LTOT assessment
clinic via an EPR order: “Oxygen assessment
for home/LTOT - outpatient”.
Discharging patients from hospital who have
oxygen requirements - Please contact your hospital
HOSAR team with as much notice as possible to
avoid delayed discharge and to ensure an
appropriate assessment and follow up plan is
agreed. ALL Home Oxygen Ordering Forms (HOOFs)
should be completed by a healthcare professional
with appropriate training.
GSTT
KCH
Integrated respiratory
team
Integrated respiratory
team
Bleep: 1940
Air call: KH4740
Hours: Monday to
Sunday 0900 to1630
Hours: Monday to
Sunday 0900 to 1630
EPR: “ Home oxygen
order form”
Lambeth
Refer to [email protected] (48 hour
response)
Dr. Azhar Saleem on 07734 968897 for advice
Southwark
Refer to [email protected] (48 hour
response)
Dr. Noel Baxter on 07789 794708 for advice