Jump to comment:

• Oxygen Alert Cards: Are they working? Our Local Experience at Yeovil District Hospital
  Adam Hughes
  Published on: 29 April 2016

• Published on: 29 April 2016

  Oxygen Alert Cards: Are they working? Our Local Experience at Yeovil District Hospital

  • Adam Hughes, Foundation Year 2 Doctor
  • Other Contributors:
    • Dr R K Sinha, S Leeman

  In Yeovil District Hospital (YDH), o2 alert cards are currently issued by the respiratory nurse specialist. Patients are usually referred by a doctor or the ward nurses for a respiratory nurse review to optimise management of a respiratory disorder and arrange appropriate follow up in the community. If a patient has a documented episode of type II respiratory failure the respiratory nurse will issue an o2 alert card as...

  Show More

  In Yeovil District Hospital (YDH), o2 alert cards are currently issued by the respiratory nurse specialist. Patients are usually referred by a doctor or the ward nurses for a respiratory nurse review to optimise management of a respiratory disorder and arrange appropriate follow up in the community. If a patient has a documented episode of type II respiratory failure the respiratory nurse will issue an o2 alert card as recommended by BTS. A retrospective audit was carried in Yeovil District Hospital in 2013 to determine if oxygen alert cards are achieving their intended purpose. This included assessing whether alert cards were issued correctly to at-risk patients and to review the compliance of oxygen administration in both ambulances and hospital with BTS guidance. 79 patients were issued o2 alert cards over the 12 month period; 63 notes were available and audited. The results showed that all patients audited had a documented ABG confirming an episode of hypercapnoea; the majority of which had a diagnosis of COPD. Of those 63 patients audited, 19 patients were readmitted with a total of 38 admissions. Therefore the average number of re-admissions per patient was 2 (range: 1-5) During 33 of these episodes the patient was brought to hospital via ambulance. There were only 2 ( reports of alert cards being shown and appropriate venturi masks being issued to the ambulance staff. Furthermore on 76% of episodes, o2 administered in the ambulance was not appropriate and oxygen saturations exceeded the targeted 88-92%. On arrival to hospital there were no recordings of any alert cards being shown to staff and issued with the appropriate venturi mask. On first saturation measurement whilst in hospital only 29% were within the target range and in over 50% these were not acted on appropriately. During the admissions, there were 8 incidents where an ABG was not preformed. However, in the remaining 30 admission episodes in which an ABG was preformed, appropriate action and oxygen titration was carried out in 90% of the episodes. It is clear from this audit that currently, in Yeovil District Hospital, the o2 alert cards issued to patients are not being used. The audit has also demonstrated that oxygen administration in both ambulatory services and hospital setting are not following the current recommendations set by BTS in regards to the administration of oxygen to patients at risk of hypercapnoea. Patients are continuing to be inappropriately administered oxygen and are being put at high risk of the potentially dangerous side- effects of high-flow oxygen. It appears from the study that in the majority of patients it is only after an ABG that oxygen administration levels are appropriately titrated. However, worryingly not all patients have an ABG on admission. There are probably a number of reasons why the o2 alert cards are not currently working. The alert cards are a relatively new scheme in Yeovil District Hospital and therefore education will play a crucial role for improving the use of o2 alert cards. Patient and carers will be targeted as the main source of education and it is hoped that providing them with BTS leaflets on oxygen administration will increase understanding. Obviously education of health professionals will also be important to raise awareness of the scheme and guidelines. Communication between primary and secondary services is another area that could possibly develop; one idea is that the home address and ideal oxygen dose or target saturation ranges of at-risk patients could then be flagged in the ambulance control systems and communicated to ambulance crews when required. A further idea is that the name of the o2 alert cards could be changed to something which implies a more serious danger hopefully this would encourage the use by patients similar to the reporting of drug allergies.

  Conflict of Interest:

  None declared

  Show Less

  Conflict of Interest:
  None declared.

  • Back to top