Home Oxygen Therapy:
Complying with NPSG.15.02.01
• Flammable clothing
• Lack of smoke detectors or the
presence of non-functional smoke
detectors
• Patient suffers from cognitive
impairment
• Patient living alone
Risk Assessment
Home oxygen therapy requires careful
planning and monitoring to prevent fires.
J
oint Commission’s NPSG.15.02.01
requires home care organizations
to identify the specific risks associated with home oxygen therapy, such
as home fires. In a 2008 National Fire
Protection Association report, home
oxygen therapy was found to be a contributing factor in an average of 1,190
burns per year, as seen in U.S. emergency rooms. Moreover, from
2002–2005, fire departments
responded to an average of 182 home
fires per year in which oxygen administration equipment was involved in
ignition. Forty-six people per year died
in these fires.1
Common risk factors that health
care organizations should watch for
when assessing home fire risk include:
• An identified history of smoking
while oxygen is running
Page 9
“A home care organization’s first step
in oxygen safety is to perform a risk
assessment,” says Diane Flynn R.N.,
M.B.A., Joint Commission home care
surveyor. Before home care organizations that supply oxygen can provide
proper education in the risks and use
of the equipment, the organization
must perform a comprehensive assessment and identify the specific risks in
each patient’s home. A home monitoring program and follow-up should be
put into place as well, particularly in
cases in which a patient is determined
to be at high risk.
The final assessment should be of
the patient’s comprehension of identified risks and suggested interventions.
Compliance will need to be reviewed
periodically, especially with patients
identified as suffering from cognitive
impairment.2
Smoking and Home Oxygen
Smoking is by far the leading cause of
burns, reported fires, deaths, and
injuries involving home medical oxygen. Smoking materials are the leading
heat source, comprising 73% of medical oxygen–related burns seen at
hospital emergency rooms.1
If a risk assessment has demonstrated that a patient smokes or there
are smokers in the patient’s home, the
family must be educated in safety
guidelines. For example, smoking may
occur if the oxygen unit is shut off and
the patient or family member agrees to
only smoke outside of the home.
The National Fire Protection
Association recommends that smoking
never occur in a home where oxygen is
used and suggests that patients post ‘no
smoking’ signs in and outside of the
home to remind residents and guests
not to smoke.
The home care organization may
want to consult its ethics committee or
organization leadership regarding the
termination of services to a patient
who has had a history of smoking
while oxygen is running or is noncompliant with precautions.
Flammable Clothing, Open
Flames, and Other Home
Heat Sources
While the danger of a lit cigarette is
obvious, some other fire risks might be
less apparent and must be included in
patient education. While oxygen itself
is not flammable, it is necessary for fire
to burn and its presence in high concentrations will make a fire burn faster
and hotter–turning a tiny spark into a
conflagration.
Materials such as wool and nylon
can produce static electricity when
combined with friction, such as when a
patient walks in socks on a nylon carpet or removes a wool sweater. In an
oxygen rich environment, a static spark
can cause a burn or a fire.
Candles and gas stoves should be
avoided when using medical oxygen.
Patients should stay at least six feet away
from any open flame or other heat
source when using their oxygen system.
If a patient must cook while using oxygen, tubing should be positioned behind
the patient or tucked into his or her
The Joint Commission Perspectives on Patient Safety, October 2010, Volume 10, Issue 10
Copyright 2010 Joint Commission on Accreditation of Healthcare Organizations
Home Oxygen Therapy
(continued from page 9)
shirt, to avoid coming into contact with
the gas flame or electric burner.4
Patients Suffering from
Cognitive Impairment
As part of the initial safety assessment,
home care organizations should identify the patient’s level of comprehension
of and ability to comply with identified
risks and suggested interventions.
Patients identified as suffering from
cognitive impairment will need added
assistance in setting up a home environment conducive to safe medical
oxygen use. Home care organizations
will need to ensure a home health aide
or family member adequately understands the safety risks and precautions
he or she may need to take on behalf of
the patient.
Some oxygen use precautions offered
by Cleveland Clinic Health System
could be implemented by a patient’s
family member or caregiver. These precautions include the following4:
• Be sure that all electrical
equipment in the area near the
oxygen is properly grounded.
• Secure floor mats and throw rugs
so that patient will not trip or fall
when using an oxygen system
• Keep the oxygen system properly
secured, in a well-ventilated area,
and in a place where it won’t get
knocked over
• Keep the oxygen system clean and
dust-free
Patients Living Alone,
Sentinel Event Alert #17
The Joint Commission reviewed 11
sentinel events in which home health
care patients using supplemental oxygen were injured or killed by fire.3
Living alone was among the common
risk factors. When a fire or burn
occurs, these patients are most at risk
of injury or even death.
Page 10
Home care organizations might consider the following3:
• Place a phone near the bed or
chair of people who may have
difficulty escaping a fire.
• Make sure that the home has
working smoke alarms. Test them
at least monthly.
• Have a fire extinguisher easily
accessible in the home and make
sure the patient knows how to use
it.
• Have a home fire escape plan
with two ways out of every room
and practice the plan at least
twice a year.
• Notify patient’s electric company
if he or she is using an oxygen
concentrator system so they can
make that house a priority during
a power outage
http://www.nfpa.org/assets/files//pdf/
os.oxygen.pdf (accessed August 15, 2010).
2. The Joint Commission: Comprehensive
Accreditation Manual for Home Care.
Oakbrook Terrace, IL: The Joint Commission,
Jul. 2010.
3. The Joint Commission: Lessons learned: Fires
in the home care setting. Sentinel Event Alert.
Mar. 2001. http://www.jointcommission.org/
SentinelEvents/SentinelEventAlert/sea_17.htm
(accessed Sept. 7, 2010).
4. The Cleveland Clinic: Home Oxygen Therapy.
http://www.cchs.net/health/health-info/docs/
2400/2412.asp?index=8707 (accessed Sep. 7,
2010).
While home fires are a significant risk
for the home oxygen therapy patient,
other risk factors can be mitigated as
part of an educational program including the following examples:
• Patients may not be getting the
amount of oxygen his or her
doctor has prescribed.
Organizations can test to ensure
that the oxygen is delivered at
proper levels.
• Improperly stored tanks, which
can fall and rupture, could act as
a “torpedo” smashing through
walls and could injure anything
in their path.
• Loose cords or extra tubing can
be trip and fall hazards
• Patients living far from their
oxygen supplier should have
backup tanks available in case
they run out and severe weather
conditions make delivery difficult
PS
References
1. Ahrens M.: National Fire Protection
Association: Fires and Burns Involving Home
Medical Oxygen, Aug. 2008.
The Joint Commission Perspectives on Patient Safety, October 2010, Volume 10, Issue 10
Copyright 2010 Joint Commission on Accreditation of Healthcare Organizations