Home Oxygen Assessment Care Pathway

Review in progress

Disclaimer: The guidance contains helpful primary care information for management of referrals and up to date referral criteria. These guidelines are locality specific to best reflect local services. This guidance does not override or replace the individual responsibility of healthcare and social care professionals involved in the delivery of care to make informed professional judgements appropriate to the circumstances of the individual.

Scope

This guidance refers to:

  • Referral for assessment of all patients age 18+ who require Home Oxygen

This guidance does not cover:

  • Under 18s

Assessment

Resting pulse oximetry: see Pulse Oximetry Guidelines
  • Make sure the patient has been resting for at least five minutes prior to measurement
  • When documenting saturation always comment on whether the reading was on air or supplemental oxygen, and at rest or on exertion
  • Wait 5-10 minutes after a change in oxygen therapy for the saturation to stabilise
  • A healthy person at sea level should have a saturation of 95% or more, However, in some patients, especially those with COPD, there is a risk that oxygen therapy may aggravate ventilatory failure. In these patients a target saturation of 88% - 92% may be appropriate
  • In most other circumstances a target saturation of 94%-98% is reasonable
Flight Assessment:

BTS guidance suggests a person planning to fly requires assessment if:

  • SPO2 92 – 95% with associated risk factors*
  • *Risk factors are hypercapnia, FEV <50% predicted, Lung Cancer, restrictive lung disease, kyphoscoliosis, on non-invasive ventilator support, co-existing cardiac or cerebrovascular disease, within 6 weeks of admission for acute exacerbation
  • The patient is using Long Term Oxygen Therapy

Refer to Respiratory Specialist Team for assessment

Red Flags

Seek immediate or urgent specialist advice/treatment if:

A very low saturation (below 85%) should prompt an urgent discussion with the respiratory team. Having a record of a patient's usual saturation is useful, as a sudden drop should prompt a search for a cause or even an admission if the patient is unwell

Contact the Respiratory Specialist Team urgently to discuss –01977 747437, fax 01977 747441

Management

Oxygen is not a treatment for breathlessness even in palliative care:

  • Do Not issue oxygen if Sp02 is >92%,
  • Do Not issue oxygen if the patient is unstable

Quality assured diagnosis of COPD (refer to diagnosis guidance) and patient clinically stable for 5 weeks

  • Assess oxygen saturations using pulse oximetry (SpO²) at least 6 monthly for all patients complaining of breathlessness despite optimised medication or FEV1 <1.5ml or <40%

SpO² greater than 92%

SpO² 92% or below

  • Routine referral to Respiratory Specialist Team for home oxygen assessment
  • SpO² 85% or below Urgent referral to Respiratory Specialist Team –01977 747437, fax 01977 747441

Referral

Referral Criteira

  • Please refer all patients in whom oxygen is being considered for non-palliative care reasons directly to the Respiratory Specialist Team for assessment
  • If home oxygen is issued:
    • Non oxygen specialist clinicians can only order static supply of oxygen on a temporary basis
    • It is the responsibility of the ordering clinician to ensure the patient receives appropriate follow up and review after 4 weeks and 6 monthly from then on
    • NEVER issue oxygen at the request of another clinician, they should be asked to complete the order themselves or refer to the Respiratory Specialist Team
  • Pulmonary Rehabilitation (Wakefield) - see referral form for criteria

Referral Instructions

  • e-consultation is available for those patients with an SpO² of 92% - 86% on pulse oximetry
  • Respiratory Specialist Team - Written or telephone referral for respiratory opinion to 01977 747437, fax 01977 747441
  • Referrals to Pulmonary Rehabilitation (Wakefield) via a completed referral form which should be faxed to:: 01977 668748

Supporting Information

Shared Decision Making

  • Patients have a right to make decisions about their care and should be fully informed about the options they face. They should be provided with reliable evidence-based information on the likely benefits and harms of interventions or actions, including any uncertainties and risks, eliciting their preferences and supporting implementation.

Patient information/Public Health/Self Care

Supporting information

Evidence/ Additional Information

Assurance & Governance

  • This guidance was developed on: 02.2017
  • This guidance was ratified by: The OSCAR Assurance Group
  • Date ratified: 05.2017
  • Publication Date: 05.2017
  • Review Date: 02.2019
  • Ref No: RS3 - 02.2017
Any feedback or suggestions to improve this guidance should be sent to: oscaradmin@this.nhs.uk
Only the electronic version is maintained, once printed this is no longer a controlled document

 

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