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170 A closed loop audit on oxygen prescription in the emergency department in Ipswich Hospital
  1. Ellhia Sudin,
  2. Devraj Kathwadia,
  3. Eddie Udofa,
  4. Abhijit Bose
  1. Ipswich Hospital


Aims/Objectives/Background The British Thoracic Society (BTS) produced the world’s first guidelines on oxygen therapy in the emergency setting in 2008, with subsequent updates in 2017. The key recommendation was that oxygen should be prescribed with target saturations tailored to individual patients.

Whilst most clinicians appreciate the dangers of under-oxygenation, there is a lesser regard for the dangers of over-oxygenation. This is particularly important in certain conditions which may predispose to hypercapnic respiratory failure and acidosis.

We therefore set out to assess compliance to the BTS guidelines, and to educate clinicians on the importance of good oxygen prescribing practice.

Methods/Design The first cycle was conducted in August 2019. The results were presented in a series of departmental teaching sessions, along with the BTS recommendations and the importance of good oxygen prescribing practice. The second cycle was later conducted in April 2020.

For each cycle, we randomly selected records of 50 adult patients who either: (1) arrived with oxygen saturations less than 93%; or (2) were already on oxygen on arrival to the emergency department. For each record, we assessed whether the target oxygen saturations were prescribed.

Results/Conclusions A total of 100 patients were included in this study. Prior to the departmental teaching sessions, only 14% of patients had target oxygen saturations prescribed. The teaching sessions on oxygen prescription resulted in a small but statistically non-significant improvement in oxygen prescription to 20% (p=0.595).

This study shows that departmental teaching sessions alone are not sufficient to improve compliance with oxygen prescribing practice. Further efforts are required to change ingrained behaviours and culture, particularly in settings such as the emergency department with high rates of clinician turnover and ad-hoc locum cover. Further recommendations to facilitate these changes will require engagement from the multidisciplinary team, such as prompting from the nursing team, and spot checks by senior clinicians.

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