Doctors are told to curb overuse of oxygen in hospitals

This was in today's newspaper very interesting given theme of my last oxygen post.

Study highlights dangers of unprescribed therapy and calls for better NHS training in what constitutes a safe ‘target range’ of oxygen in the body.

Patients are being given potentially fatal amounts of oxygen because hospital staff are unaware how much they should administer, a new study warns.

Lung specialists want doctors and nurses to be given more training in what constitutes a safe “target range” of oxygen in the body, otherwise there is a danger patients may suffer greater illness, and in rare cases even death.

Oxygen is one of the most commonly administered therapies in the NHS – every day one in seven of all patients is given oxygen. But, unlike drugs, it is administered in NHS hospitals without prescription to about 6,000 people on an average day.

“In a modern health service, it is concerning that so many patients in hospital are still being given this therapy without any form of prescription,” said Dr Ronan O’Driscoll, consultant respiratory specialist at Salford Royal NHS Foundation Trust, who led the study on behalf of the British Thoracic Society (BTS).

“The situation would not be tolerated for any other drug – even a common ‘over the counter’ treatment such as paracetamol requires a prescription or other written order in hospital. Oxygen is very beneficial to many patients, but it can be harmful if misused.”

The giving of too little oxygen, a well-documented problem, can be caused by staff not noticing they are connecting empty cylinders or the accidental use of air instead of oxygen.

But experts believe that the supply of too much oxygen, a less well-known problem, can be attributed to its availability without prescription and a lack of adequate training among medical staff.

“Oxygen is an important drug and should always be prescribed and documented in hospital like any other medication,” O’Driscoll said.

“When used, prescriptions and monitoring documents give us a vital record of which patients are receiving oxygen, how much they are getting, and by what method. But, crucially, they also set a personalised ‘target range’ for each patient, indicating a desirable, safe level of oxygen in the blood that hospital staff can measure and keep within.”

Patients with lung diseases such as chronic obstructive pulmonary disease (COPD) are most vulnerable to over-oxygenation. Their damaged lungs are unable to cope with high levels of oxygen and as a result they can fail to expel the resulting carbon dioxide effectively, which can lead to a form of acute respiratory failure.

The BTS says death rates in hospitals for people with COPD have fallen from 7.8% to 4.3% when oxygen prescriptions have been provided, saving 3,000 lives a year. But a recent audit by the society found that more than half of NHS hospitals surveyed do not supply sufficient training for staff around oxygen provision. It revealed that 44% of patients using oxygen were at risk from excessive oxygen therapy.

It also found that, even when a written prescription was provided, almost a third of patients were still getting either too little or too much oxygen. Of particular concern was that almost one in 10 patients who had been prescribed a “target range” were found to have been administered more than 2% above it.

“In the audit, the number of patients whose blood oxygen levels were too high after oxygen therapy is concerning,” O’Driscoll said. “This may be because staff believe oxygen deficiency is a much greater danger than oxygen overload, leading to a possible feeling that ‘the more oxygen we give the better’.”

[undine]

I was in hospital in December and ended up in the ICU on a ventilator and nearly died twice through I am sure being given too much oxygen TWICE - of course the hospital deny this and ended up blaming me for being a Co2 retainer which tests later showed I was not - needless to say I am terrified now of ending up in hospital - if they deny making this mistake it will not be rectified and that is what is frightening. thanks for post xxx

[Hidden in reply to undine]

I am so sorry to read about ya latest ... Your not the only one livening in fear of fake doctors nurses killing us.

Lucky when ever I have been I have always had good experience BUT is on my record I luv litigation

[Dorris59 in reply to undine]

Too much Oxygen is dangerous for CO2 retainers, not if you aren't, so if you are a retainer, then it would be their fault if they gave you too much. They usually monitor blood gases in retainers and restrict the amount of Oxygen accordingly. For instance giving 2L to a CO2 retainer could be far too much, but CO2 retainers can still have a bit of Oxygen. My mum is on Oxygen at home, but only has half a litre as needed, such as when her SATS fall and it's taken off when they rise to about 93%. They have given my mum a card to carry with her in the event of an emergency, stating she is a CO2 retainer and that she shouldn't be given above a certain amount of Oxygen and also what her range of SATS should be as a COPD patient. The Oxygen assessment unit wanted to take her Oxygen off her altogether, but her GP has insisted she needs some. Check out what the protocol is for COPD patients on the NICE guidelines and ask for an Oxygen assessment.

[undine in reply to Dorris59]

I too am on a half a litre of oxygen rising to 1 litre when walking, moving etc. and have been told by different professions that I am either a co2 retainer or that I am borderline or that I am not - so do not know what to believe. I also had a card to give to the hospital warning the hospital that I had COPD but that was ignored so I now have bought a wrist band that I wear all the time just in case, and had problems with the oxygen assessment people in the last area I lived in who also were trying to take me off oxygen so your Mum and I seem to have a lot in common -please give her my best wishes xx

[Dedalus]

Thanks for that Jeff - good to know

[Peteybob]

Hi Jeff and thanks for posting this article. It is well worth reading. This serves as a reminder to me of articles like this which I read about a year ago from journals both in the US and GB. The studies then questioned the same items of too much or too little oxygen being given. This was both in hospitals and emergency vehicles.

Now that I know my lungs are very hyper inflated and trap co2 I will always ask (if able or thru a home caregiver) if the ambulance or hospital knows what an appropriate amount is for me. I will also bring this up with my doctors as I see them next month.