EMERGENCY OXYGEN THERAPY IN ADULTS: PROFESSIONAL COMPLIANCE AND EDUCATION

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, 70^th 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.