In the last few months, I have been introduced to the passionate and sometimes stressful world of research, specifically in research in health and social care. As part of my learning I developed a research proposal which is partially shown here.
Although I am still far from expert, I think the literature review brings up some interesting questions. Also, constructive feedback is always welcome.
EMERGENCY OXYGEN THERAPY IN ADULTS: PROFESSIONAL COMPLIANCE AND EDUCATION.
INTRODUCTION
Oxygen is probably
the most common drug used in medical
emergencies and its inappropriate administration can have serious or even fatal
consequences (BNF 70). The literature review carried out by Ingrid Nippers and
Andrew Sutton in 2014 states that there is evidence that oxygen therapy is not
being prescribed, administered and monitored correctly. They suggest the
implementation of planned audits and educational programs for staff to ensure
adherence to both local and national guidelines.
The aims of this study
are to measure the level of professional compliance with local guidelines when
administering oxygen therapy and to assess the effectiveness of educational
interventions in the acute settings of the Belfast Health and Social Care
Trust.
The objectives of this
study are to obtain information about the current situation of oxygen
administration, to provide high quality training tackling all aspects of oxygen
therapy and to evaluate the success of the educational program in practice.
In order to achieve these
objectives, a quantitative approach has been chosen, it is an experimental
study before and after a training session. It will take place in the Emergency
and Medical Admissions departments at the Royal Victoria Hospital and the Mater
Hospital, both under the Belfast Health and Social Care Trust policies and
guidelines.
Although the Belfast
Trust is in process of developing a new policy, audits (as per Health &
Care Audit Activity Report May 2015) and has a mandatory training in Medical
Gases, there is no information available about professional compliance
regarding oxygen therapy at present or evidence of the actual success of the
Medical Gases training. Also, no audits are carried out (at the moment of developing this study) which means that oxygen
use is not being evaluated.
BACKGROUND
In 2008, the first formal
guidance on emergency oxygen use was produced by the British Thoracic Society.
These guidelines have been already criticised by Smith et al. (2012) regarding
the target saturation of oxygen for actively treated patients not at risk of
hypercapnic respiratory failure. Nippers et al. (2014) states that it has
limited evidence, which affects its reliability, and the National Patient
Safety Agency recommends further documents for clinical guidance as the BTS
(2008) does not cover critical care or children under 16 years. There is a
clear need for consensus, clinical guidance should be developed covering all
areas of oxygen therapy and kept up to date with recent research. It is beyond
this study to develop latest up-to-date guidelines so, the policy from the
Belfast Trust regarding oxygen therapy will be the one used to develop the
instrument for data collection.
Organizations like the
National Institute for Health and Care Excellence do not have any clinical
guidelines about oxygen.
Also, the medical use of
oxygen needs to be further examined in search of solid evidence of benefit in
many of the current clinical settings in which is routinely used as stated by
Sjoberg et al. (2013).
A rapid response report
from the NPSA was issued in 2009 after receiving 281 reports of serious
incidents related to inappropriate administration and management of oxygen,
also, Kane et al. (2013) states that oxygen therapy is often used incorrectly
and the dangers of over-oxygenation are unappreciated.
The literature review
suggests an incorrect administration tendency in oxygen therapy and a lack of
awareness in its dangers, this project has developed an approach that will
study both issues.
A quantitative approach
has been chosen as it allows to measure objectively the level of compliance,
the collected evidence can be transformed in numerical data which can be
statistically manipulated to obtain the answer for the research question
(Gerrish and Lacey, 2010).
In order to assess the
administration of oxygen before and after an educational intervention, a pre
and post intervention study will be done as it is an experimental design that
reports a change in an outcome following a change in an intervention (Gerrish
and Lacey, 2010). Being able to manipulate and
compare the pre and post intervention data will give an overview of the
professional compliance and the success of the intervention in practice.
References
-Gerrish, K. and Lacey, A.
(2010) The Research Process in nursing. 6th Edition. United Kingdom:
Wiley-Blackwell.
-Kane, B., Decalmer, S.,
& Ronan, O., B. (2013). Emergency oxygen therapy: From guideline to
implementation. Breathe, 9(4), 246-253.
-Nippers, I., &
Sutton, A. (2014). Oxygen therapy: Professional compliance with national
guidelines. British Journal of Nursing, 23(7), 382-386.
-O'Driscoll, B.R., Howard,
L. S., & Davison, A. G. (2008). BTS guideline for emergency oxygen use in
adult patients. Thorax, 63 Suppl. 6, vi1-vi68.
-Kor, A.C., Lim, T.K.
(2000) Audit of oxygen therapy in acute general medical wards following an
educational programme. Annals of the
Academy of Medicine Singapore, 29, 2, 177-181
-Sjöberg, F., &
Singer, M. (2013). The medical use of oxygen: A time for critical reappraisal.
Journal of Internal Medicine, 274(6), 505-528.
-Smith, G. B., Prytherch,
D. R., Watson, D., Forde, V., Windsor, A., Schmidt, P. E., et al. (2012).
S(p)O(2) values in acute medical admissions breathing air--implications for the
British thoracic society guideline for emergency oxygen use in adult patients?
Resuscitation, 83(10), 1201-1205.
-Formulary Committee Joint
Cover: Paperback. (2015). Oxygen. British National Formulary, 70th
Edition, September 2015-March 2016. United Kingdom: Pharmaceutical Press, page
214.
-National Patient Safety Agency. (September 2009).
Rapid Response Report: Oxygen safety in hospitals. Available at: www.nrls.npsa.nhs.uk/alerts.
Note: this is just a proposal done for an assignment, it will not be developed any further.
