Guidelines for Nurses to ensure efficient
delivery of oxygen to patients requiring LTOT
| (1) | A
standard prescription sheet should be used |
| | When
ordering LTOT use a standard prescription sheet. (Formulated by the Hospital or
the Oxygen Supplier) |
| (2) | The
Prescriptions Sheet should contain the following information |
| |
Name, address, DOB and hospital number of the patient
Contact name and residential
or mobile phone number of carers to arrange delivery. (Place of discharge can
be either the patient's home or a residential home)
Diagnosis
Contact number
at hospital site (Respiratory CNS or Ward Manager)
Equipment: Oxygen Concentrator
or/and portable oxygen.
Fill in Medical Card Number if applicable
|
| (3) | The
prescribing doctor should complete the following on the prescription form |
| | Whether
concentrator and/or portable oxygen is required
Oxygen Flow Rate
Hours per
day the patient requires oxygen
Humidifier if required
Consultant
Signature
of prescribing doctor
|
| (4) | What
to do with the prescription |
| | (A)
For medical card holders
Fill in the medical card number on the request
form and Fax the completed request form to the appropriate community care area
followed by a hard copy in the post. Once approved by the appliance officer they
will inform the oxygen suppliers who will arrange delivery.
(B) For Non
medical card holders
Fax the completed request form to the oxygen suppliers
followed by a hard copy in the post. The oxygen suppliers will arrange delivery.
|
| (5) | Medical
Cost Entitlements |
| | In
Ireland the company rents domiciliary oxygen equipment monthly to the health board
or the patient.
(A) Medical card holders are entitled to full cost cover for
the monthly rent of oxygen.
(B) Non medical card holders are entitled to cover
under the drug subsidisation scheme for the monthly rental of oxygen (the form
can be obtained from the local pharmacy)
Servicing and replacement of equipment
is included in the monthly rent.
Be aware that electricity is a hidden cost
(social worker can advise patients on this)
|
| (6) | Points
to remember |
| | When
ordering portable oxygen for patients with a medical card it can be helpful to
record pre and post exercise saturation. In some health boards or community care
areas the community physiotherapist is required to visit the home to assess further
the patients need for oxygen.
|
| (7) | Patient
Education is vital and the following points should be included. |
| | The
reason for LTOT
Duration of therapy (minimum of 15 hours per day)
Illustrate
the equipment if possible. Information booklets on the use of oxygen are available
from suppliers and should be given to the patient
Remember to include family
members or carers in the education session
Advise patients not to tamper with
flow rates
Cleaning is done according to the instruction manual. Nasal prongs
should be changed monthly.
Water base lubricants should be used if required
for the nose or mouth.
The company provides maintenance of the equipment and
servicing should be 6 -12 monthly. A back up cyclinder will be provided in event
of a power failure.
|
| (8) | Smoking |
| | Assessment
of patients smoking statues should be carried out prior to prescribing oxygen.
Smokers who are still smoking should be offered smoking cessation advise and
quit date fixed with follow up at smoking cessation clinic. The patient should
be commitment to smoking cessation.
The dangers of smoking and using oxygen
should be highlighted.
|
| (9) | Safety
Issues |
| | A technician
from oxygen suppliers will install the oxygen concentrator
The patient and
the family should be advised that Oxygen could be dangerous.
Never use oils
or grease on oxygen equipment
Oil based lubricants increase the risk of combustion
as well as clogs the nasal prongs therefore reducing oxygen flow.
Turn off
the oxygen supply when it is not in use
Patient should be advised on the fire
risks when receiving oxygen therapy. Install a smoke detector in the home and
keep an appropriate fire extinguisher at home.
Connection leads should be secure
at all times
|
| | Equipment
Concentrators
Oxygen
concentrators are floor standing electrical driven devices that uses room air.
It removes nitrogen by a process of filtration and delivers oxygen at the outlet.
The concentrator must run at all times that oxygen is been delivered.
Concentrators
can be wheeled around but are heavy (21-26 KGs). The approximate sizes of concentrators
are 68cms high, 45 cm wide and 34cms deep. Extension leads can be used for upstairs
and outdoor use
Cylinders
These contain compressed pure oxygen and
deliver oxygen at the outlet. Size and content vary and a regulator, flow meter,
spanner and key wheel are needed to connect the tubing to the cylinder. Cylinders
are not used generally in the community.
|
| | Reading
Material |
| | (1)
COPD Guidelines Group of the standard of Care Committee of the British thoracic
society. BTS guidelines for the management of chronic obstructive pulmonary disease.
Thorax 1997; 52 (Suppl 5):1-28(2) Domiciliary Oxygen Prescribing Services.
Clinical guidelines and advise for prescribers. London. Royal College of Physicians,
1999 (3) Management of passengers with respiratory disease planning air
travel: British Thoracic Society Recommendations
Thorax 2002:57: 0-15 (4)
Chandler T. Oxygen administration. Paediatric Nursing 2001; 13: 37-42 (5)
Ring, Lena; Danielson, Ella (1997) Patient's experience of long -term oxygen therapy:
Journal of Advanced Nursing: 26, 337-344 (6) AARC Clinical Practise Guidelines.
Oxygen therapy in the home and extended care facility. Respiratory Care 1992;
37:918-922 (7) Even H Young, Alan J Crockett and Christine F Mc Donald.
Adult Domiciliary Oxygen Therapy.MJA 1998:168: 21-25 (8) Standard for the
diagnosis and care of patients with chronic obstructive pulmonary disease. ATS
Official Statement. Am. J. Respir. Crit Care Med 1995; 152 Suppl: 77-120 (9)
Recommendation for long term oxygen therapy. Report of a European Society of Pneumology
Task group. Eur. Respir J 1989; 2: 160-165
|
| |
Asthma:
www.ginasthma.com/GuidelineList
www.brit-thoracic.org.uk
COPD:
www.nice.org.uk/guidance/index
www.brit-thoracic.org.uk
Emergency Oxygen:
www.brit-thoracic.org.uk
Home Oxygen Service:
www.brit-thoracic.org.uk
Hospital at Home for COPD:
www.brit-thoracic.org.uk
Lung Cancer Guidelines:
www.nice.org.uk/guidance/index.jsp
Non-Invasive Ventilation:
www.brit-thoracic.org.uk
NIV Policy Document
Occupational Lung Disease:
www.brit-thoracic.org.uk
Palliative Care
www.hospice-foundation.ie
Palliative Care For All - KEY MESSAGES
Pneumonia:
www.brit-thoracic.org.uk
Pneumothorax:
www.brit-thoracic.org.uk
Pulmonary Embolus:
www.brit-thoracic.org.uk
Pulmonary Rehabilitation:
www.brit-thoracic.org.uk
Sleep Apnoea:
www.brit-thoracic.org.uk
Travel
http://www.brit-thoracic.org.uk/clinical-information/air-travel/air-travel-guideline.aspx
Tuberculosis:
www.nice.org.uk/guidance/index.jsp
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