National Guidance / Best Practice
Contents
1. System Does not permit travel to other locations Requires assessment in clinic Arrangements for mounting compressor could be better flats tenements Fixed predetermined deliveries once a fortnight Storage of large volume of gas Risk of cryogenic burns Older style portable needed For high flows Increased risk in event of fire Expensive deliveries of cylinders May Need to use several low flow probes when weaning children off oxygen Should be backed up with concentrator or large cylinder quiet situations Click Patients require ongoing support with conserver Some compatibility issues with other types of cylinder Battery operated so needs replacement batteries 24 Appendix 4 Equipment Specifications Attribute Regular Oxygen Concentrator High Flow Concentrator Portable Concentrator Homefill System Liquid Oxygen BabyOx Portable Cylinder with Conserver Pattern of Use Short burst Temporary palliative care pre LTOT assessment Long term static Portable non ambulant Ambulatory High flow rate gt 5L min Low flow rate children with low flow meter Duration 8hrs X Low flow type Isolated location High rise tenement Poor manual dexterity compreh ension Humidifier 29 Appendix 5 Sample Protocol for Withdrawal of LTOT Ambulator2. e These patients require to be closely followed up e Patients who are known to be oxygen sensitive should be issued oxygen with extreme caution and an oxygen alert card recommended e Portable concentrators that are issued should be recovered by the out of hours service within a week as per agreed local protocols 12 0 DISCHARGE PLANNING Where a patient is being considered for oxygen at home they should be referred to respiratory medicine services at the earliest opportunity Non respiratory specialists should not prescribe home oxygen for adults unless on the local oxygen prescribing register e g cluster headaches 13 0 ANTICIPATORY CARE PLANNING Should be considered for all patients who meet the criteria for LTOT Standard Response Times for Home Oxygen Services Activity Type Standard Installation Lox Installation and delivery Lox replenishment Standard replenishment Urgent Palliative Emergency Installation Definition Items applicable Installation of equipment lt 4 All except Lox business days Installation of Lox Scheduled Lox deliveries Replenishment of supplies Installation 2 working days Installation 11 Lox reservoirs portables and accessories Lox reservoirs All except Lox All Concentrators Cylinders Action within lt 4 business days lt 10 business days Weekly fortnightly or monthly schedule No requirement to place orders lt 4 busi
3. repeat on oxygen O2 flow should e Perform walk test using air maintain SaO gt 90 on exercise measuring walking distance Compare distance walked and drop in SPo2 Perfom walk test distance and SPO2 on O via nasal cannula from lightweight cylinder starting 1 0 L min If distance increases by 10 and AMBULATORY SaO is maintained above 90 then patient may be suitable OXYGEN for trial of Ambulatory O 22 Appendix 4 Equipment Specifications Attribute Regular Oxygen High Flow Portable Homefill Liquid Oxygen BabyOx Portable Cylinder Concentrator Concentrator Concentrator System with Conserver Basic DeVilbiss 515 Integra 10 litre Sequal Eclipse Homefill 2 Helios Marathon CD cylinder Ecolite 4000 Oxygen Specification 5 litre Weight 25 8 Kg 3 Litre System 850 Weight 3 2 Kg Weight 24 5 Kg Dimensions Weight 8 1 Kg Weight 23 5 Weight 2 5 Kg Dimensions 40 x Conserver Dimensions 66 cm H x38 cm Dimensions 14 9 Kg Dimensions 38 10cm 70cm Hx40cm Wx 48cm D 49 cm H x 31cm Dimensions 66 cmH MGS 1 Litre W x35cm D W x 18cm D 38 cm Hx 51 Weight 2 1 Kg Weight 220g cm W x 40 cm D Dimensions 36 x DImensions TemA x 8 5 cm W x 3 2 cm D 8 5 cm Flowrate 0 5l m 0 10 I m 0 3 0 L m 0 2 5 I m from 0 6 L m Low flow 0 1 1 1 Requires 4 l m input Specification Continuous Continuous Continuous in 0 5 concentrator Continuous in L m in 0 1 L m and can control pulsed A Low flow L
4. consideration should be given to the suitability of the patient and the environment in which the equipment will be used e Oxygen concentrators are dependent on the mains electricity supply which may be subject to delay disruption or disconnection in unforeseen circumstances for this reason it is essential that Home oxygen users Are not dependant on oxygen as a life supporting mechanism Always have a backup resource usually a cylinder in case of the failure of their primary supply Primary oxygen supplies are usually provided by means of a concentrator backed up by a oylinder Liquid Oxygen LOX and Babyox service users are encouraged to use a concentrator backed up by a cylinder as their primary domiciliary supply with LOX or Babyox being used for ambulatory purposes However if Lox or Babyox is utilised as their primary supply a concentrator should still be in situ with backup cylinder as a safety measure The implications of supply disruption should be given due consideration as part of the prescribing process irrespective of the modality chosen and appropriate risk control measures put in place Local solutions should be considered by Health Boards Further advice and information is available from HFS For safety reasons smoking should not take place within a household where LTOT is being provided If this is found to be occurring reassessment of the risks and benefits should be conducted with considerat
5. are placed on a flat and robust surface where necessary to avoid overbalancing 16 2 Transport of Oxygen Equipment on Public Transport and in a Private Vehicle 16 2 1 Advice to be given to the Patient Carer e Only carry sufficient oxygen for the journey e Ensure you are trained in the correct method of operation of the equipment e Be aware of the appropriate precautions to be taken whilst using the oxygen equipment on public transport and in the event of an incident e Understand the risks associated with oxygen enrichment e Turn off the equipment when not in use e Ensure that the equipment is secure not free to roll about and where required is supported upright 16 2 2 The Oxygen Equipment should be used e As described in the user manual e In a carrying bag to keep the cylinder vessel secure e With the delivery tubing as short as possible e With the appropriate permission where required for use in tunnels 16 2 3 They should not e Leave the equipment unattended e Allow anyone to tamper with the equipment e Use a humidifier e Cover the equipment with any clothing bags or other material 16 2 4 In Private Transport in addition to those above e Ensure that the user and the driver are trained in the correct method of operation of the oxygen equipment e Use the equipment with the vehicle ventilation system set to draw in fresh air from outside the vehicle e Do not allow anyone to smoke in the vehicle e Do not use the ox
6. disease cystic fibrosis or who desaturate on exercise may be referred for assessment however there is little evidence for AO use in this group Patients with only moderate hypoxaemia PaO2 7 3 kPa and who are not on LTOT may exhibit exercise related desaturation conventionally defined as a fall in SaO of at least 496 below 90 Prescription of ambulatory oxygen can be considered if there is evidence of exercise desaturation that is corrected by the proposed device with associated symptomatic benefit See Appendix 3 7 3 Assessment and Monitoring of AO Adult Patients being assessed for AO should be tested using appropriate physiological testing equipment with respect to infection control policies procedures risk assessment and health amp safety policy and that premises are spacious enough to allow for the patient s capacity for exercise to be assessed safely Compliance with AO should be monitored to ensure most effective use following prescribing DOMICILIARY OXYGEN THERAPY NATIONAL GUIDANCE 8 0 SHORT BURST OXYGEN THERAPY SBOT There is no evidence to support SBOT the use of oxygen for short periods of time for symptomatic relief in non ambulatory circumstances Short burst oxygen therapy should not be used as a treatment for breathlessness or anxiety in the absence of documented hypoxaemia which is correctable by oxygen e Existing users of SBOT should be assessed to see if this therapy is clinically i
7. model to assist NHS Boards moving forward with their oxygen review for adults 1 National Oxygen Guideline Best Practice document dissemination made available to all NHS Boards Medical Directors Respiratory teams GP s Nurse practitioners Practice Nurses Practice managers MCN managers pharmacies patient representative stakeholders groups 2 Other Considerations How do boards access their local oxygen assessment services Is there already an established oxygen assessment service in your NHS Board Consider looking at other NHS boards that have an established oxygen assessment service Is this service provided through the local respiratory clinic in secondary care or is there and established separate oxygen assessment service How is the service configured Is it Consultant Specialist Nurse AHP led Is it based in primary or secondary care Is there a clear accountability structure in Nurse AHP led services Is there an adequate specialist respiratory workforce to deliver an oxygen service How do remote and rural boards access specialist oxygen assessment services Use of telehealth models hand held blood gas analysers examples of practice already out there Consider up skilling of workforce to carry out ABGs interpretation of results etc See DOH Home Oxygen Service assessment and review guide document April 11 3 Access to oxygen service user data HFS CHI data will be provided for all for boards GP pract
8. oxygen in children 64 Issue Supp III THORAX August 2009 www brit thoracic org uk quidelines home oxygen in children guid Moore et al 2011 A randomised trial of domiciliary ambulatory oxygen in patients with COPD and dyspnoea but without resting hypoxaemia Thorax 2011 66 32 37 doi 10 1136 thx 2009 132522 EFNS guidelines on the treatment of cluster headache and other trigeminal autonomic cephalalgias European Journal of Neurology 2006 13 1066 1077 The Gold Standards Framework Prognostic Indicator Guidance Vs 5 2008 http www goldstandardsframework nhs uk OneStopCMS Core Cra wlerResourceServer aspx resource B8424129 940E 4AFD B97A 7A9D9311BC25 amp mode link amp quid eae1921fd0694340841dbfc891be1047 accessed 25 July 2011 Department of health Home Oxygen Service Assessment and Review Good practice guide 2011 http www pcc nhs uk uploads HOS 201 1 04 home oxygen service assessment and review v3 pdf British Thoracic Society 2002 Managing Passengers with Respiratory Disease Planning Air Travel Clark A L Johnson M J Squire 2011 Does home oxygen benefit people with chronic heart failure British Medical Journal 342 pp 379 383 10 Francis G J Becker W J Pringsheim T M 2010 Acute and preventative pharmacologic treatment of cluster headaches Neurology 75 5 pp 463 473 19 DOMICILIARY OXYGEN THERAPY NATIONAL GUIDANCE 2 4 5 7 8 9 Appendix 1 Quick Guide A
9. the appropriate delivery device should be agreed by the clinician and the service user considering risks benefits and practical issues In general for long term use patients find nasal cannulae considerably easier to use than oxygen masks In circumstances where there is a significant risk of hypercapnia the convenience and general patient preference for nasal cannulae may need to be balanced against the increased risk of hypercapnia with a fixed flow rather than a fixed performance delivery device 5 2 Non COPD hypoxaemic patients Patients who have an established diagnosis on optimal medical treatment who remain hypoxaemic on two separate occasions at least three weeks apart when stable PaO lt 8 0 kPa should be considered for LTOT The evidence base for length of therapy and outcomes is less robust than for COPD patients Consider referral for people who are hypercapnic or acidotic on LTOT to a specialist centre for consideration of long term NIV In patients with COPD using LTOT evidence supports the use of supplemental oxygen for at least 15 hours per day via the delivery device that best suits the individual s needs To ensure all patients eligible for LTOT assessment are identified pulse oximetry should be available in all healthcare settings Patients receiving LTOT should be reviewed at least once per year by practitioners familiar with LTOT This review should include pulse oximetry review of oxygen use and approp
10. 31 Scenario No Patient Situation Time Current Supply Route Revised Supply Route Expected Comment Of Day Action Action Response Times COPD with exacerbation and Outof OOH doctor enge ges with OOH doctor considers OOH response time nypoxia calls NHS 24 and Out of Hoi Phe cy t ain cylinders referral to secondary care or GP writes Prescription and GP to contact Palliative care GP Pharmacy response GP presented with Palliative care Anticipatory care patient at Home and wishes to Hours cylinders Dispensed through teams in secondary care For time or hospital situation but may be initiate Oxygen 9 5 Community Pharmacy Locally provided response time or 8 required in an Concentrator Portable hours emergency 8 concentrator or oxygen delivered with 8 hours if during business hours Hospital inpatient wishes to die at Anytime 4 days 2 days or 8 Anticipatory care 9 home and Consultant wishes to hours situation but may be initiate oxygen at Home required in an emergency OOH contacted regarding Out of OOH doctor engages with OOH doctor provides OOH response time palliative care patient and OOH Hours Pharmacy to obtain cylinders portable concentrator whilst 10 doctor wishes to initiate Oxygen or uses portable awaiting further follow up in concentrator secondary care 32 Scenario No 11 Patient Situation Ad hoc cylinder supplies to Nursing Homes and Care Homes and community ba
11. ALLIATIVE CARE Refer to e The Gold Standards Framework Prognostic Indicator Guidance e ACT Guidelines for Children receiving palliative care e Appendix 1 15 0 WITHDRAWAL OF HOME OXYGEN THERAP Y Where it is clear on review that the patient is not hypoxaemic yet is in receipt of home oxygen e g SBOT he or she should be advised to discontinue and other appropriate therapies for breathlessness should be discussed Where the review indicates that the patient is no longer deriving clinical benefit from the oxygen either because the patient is not hypoxaemic or they gain no benefit from the therapy discussion should take place about withdrawing it Where the patient is not using the oxygen as prescribed but still fulfils the clinical assessment criteria for LTOT further education may be required or a reduction in the prescribed use should be considered See Appendix 5 for protocols which might be used to support this discussion Where the patient is significantly hypoxaemic but is not compliant with the prescribed oxygen therapy he or she should be counselled on the merits of the therapy and encouraged to increase usage to the recommended level Continuation of oxygen therapy should only be pursued if used as prescribed benefit from ambulatory use and continued abstinence from smoking Where an infant or child requires long term oxygen therapy but is denied this through lack of parental or carer concordance a multi disciplina
12. ESSMENT No evidence for AO May be Indicated in MERE E S COPD Sauer Rate Asthma Chronic Lung Disease with Mild Hypoxaemia and No Interstitial Lung Disease Cystic Fibrosis Desaturation DIFERCISISE Non LTOT Pulmonary Vascular Disease Chronic Heart Failure Primary Pulmonary Hypertension Cor Pulmonale e Grade 1 Patient on LTOT for up to 24hrs per day and may be housebound Low daily activity therefore occasional use using an O flow rate of that similar flow to LTOT No formal assessment required or practical e Grade 2 Patient on LTOT mobile and requiring O2 to leave home on a regular basis Assessment is required to evaluate the O flow rate required to correct exercise desaturation i e to maintain the SaO above 90 during exercise e Grade 3 Non LTOT patients with moderate hypoxaemia pO gt 7 3 kPa and may show a fall in SaO on exercise of at least 4 below 90 An assessment while breathing room air and then O should be performed using a recognised exercise test to measure improvement in exercise tolerance before considering a trial of AO Grade 1 No assessment required Will be expected to use very low volume of ambulatory oxygen ie 2 per month Grade 2 Perform walk test using air Grade 3 Non LTOT Patients via nasal cannula using lightweight Arterial ABG s PO 7 3pKa and cylinder Measure distance walked SaO dips by 4 below 90 and fall in saturation with oximetry during exercise walk test
13. NATIONAL ADVISORY GROUP FOR RESPIRATORY MANAGED CLINICAL NETWORKS DOMICILIARY OXYGEN THERAPY SERVICE NATIONAL GUIDANCE BEST PRACTICE Version 1 Published February 2012 Review February 2014 DOMICILIARY OXYGEN THERAPY NATIONAL GUIDANCE Section Content Page 1 0 Executive Summary 2 2 0 Introduction 2 3 0 Clinical Indications 2 4 0 Primary Care Pathway 3 5 0 Secondary Care Pathway 4 6 0 Paediatric Oxygen Services 8 7 0 Ambulatory Oxygen 9 8 0 Short Burst Oxygen Therapy 10 9 0 Oxygen Delivery Methods 10 10 0 Monitoring and Review of Patients on Home 10 Oxygen 11 0 Out of Hours Oxygen Service 11 12 0 Discharge Planning 11 13 0 Anticipatory Care Planning 11 14 0 Oxygen and Palliative Care 13 15 0 Withdrawal of Home Oxygen Therapy 13 16 0 Using Oxygen Therapy Practical Issues 14 17 0 Clinical Competence Skills for Oxygen 18 Assessment 18 0 Data Protection 18 19 0 Alteration to Existing Services 19 20 0 References 19 Appendices Appendix 1 Quick Guide Adult Oxygen 20 Prescription Appendix 2 LTOT Adult Assessment 21 Specialist Oxygen Service Appendix 3 Adult Ambulatory Oxygen 22 Assessment Appendix 4 Equipment Specifications 23 Appendix 5 Sample Protocol for Withdrawal of 26 LTOT Ambulatory Oxygen for Adults Appendix 6 Suggested Oxygen Review 27 Toolkit Model to Assist NHS Boards Moving Forward with their Oxygen Review for Adul
14. ational Health Service A Hypoxic Challenge assessment fitness to fly assessment should be considered in all patients receiving LTOT prior to air travel being considered 16 3 3 All Modes of Travel includes but not restricted to Aircraft Trains Cruise Ships Ferries Many travel agencies airlines and other operators have dedicated help lines for customers with particular requirements Further airline specific advice can be found here http www european lung foundation org 4059 european lung foundation elf air travel htm 16 DOMICILIARY OXYGEN THERAPY NATIONAL GUIDANCE Travellers who use oxygen should contact their chosen travel agency airline as soon as possible when planning any travel to establish what their policies and capabilities are It is important that the customer e Contacts the respective customer service department s to obtain a copy of their policy e Ensures that their equipment is on their list of authorised items e Obtains the necessary authorisation and has documentation in situ well in advance of the travel date For more information about travelling with oxygen call the British Lung Foundation on 08458 50 50 20 or visit www lunguk org and ask for a free copy of their guide Going on Holiday with a Lung Condition Also phone the Chest Heart amp Stroke Scotland Advice Line 0845 077 6000 and see the fact sheets Air travel for those affected by chest heart or stroke conditions and Holiday Infor
15. be given to the use of oxygen concentrators alongside existing cylinder supply 33 Scenario No Patient Situation Time Current Supply Route Revised Supply Route Expected Comment Of Day Action Action Response Times Patient unable to access Office Phone HFS to resolve No Change Within 10 hours if emergency cylinder oxygen from Hours problem required Dolby Medical during office hours 9 5 14 Patient unable to access Out of Out of Hours service Out of Hours service OOH response time Problem occurred on 3 emergency cylinder oxygen from Hours contacted and arrangements contacted and arrangements January 2012 Public Dolby Medical Out of Hours made through Community made through use of portable Holiday 100m h winds 15 Pharmacy or provision made concentrator and patient unable to through use of portable concentrator access emergency supplies 34
16. dult Oxygen Prescription All patients should have their smoking status updated and documented at time of prescription Patients who smoke should be referred to smoking cessation services Do not prescribe refer current smokers for oxygen therapy for health and safety reasons or as a means of incentivising smoking cessation Hypoxaemia is defined as PaO2 lt 8kPa SPO2 lt 92 in room air Hypoxaemia due to COPD Hypoxaemia due to other cause e g neuromuscular Non COPD Home Oxygen Therapy Maximise therapy as per current guidelines Does the patient have any of Sp02 s 92 on air FEV1 lt 30 Not indicated for e e Polycythaemia e e e e Recovery from seizure epilepsy Heart Failure unless palliative Palliative care Should only be considered for hypoxaemic patients who have an established diagnosis and who are distressed by breathlessness unrelieved by other therapy Patients on LTOT Refer back to Oxygen Service for reassessment and follow up Peripheral oedema Cyanosis Raised JVP Refer to specialist Consider Oxygen Service Pulmonary rehabilitation Self management Cluster Headaches Refer to neurologist in Secondary Care for assessment and prescription of High Flow 100 Oxygen z m On m LTOT vi Prescribe an oxygen ee ong erm vaxygen herapy via an oxygen concentrator through Symptom palliation concentrator will be prescribed at a suitable flow HFS R
17. eferral to secondary rate care for management Portable oxygen will be prescribed if appropriate advice not 02 Homefill Liquid Oxygen Portable concentrator or assessment Oylinder with or without Conserver will be provided LTOT assessment may still be necessary DOMICILIARY OXYGEN THERAPY NATIONAL GUIDANCE Appendix 2 LTOT Adult Assessment Specialist Oxygen Service Established Respiratory diagnosis planed dinterental NICE guidelines FEV g lt 30 Very severe airflow obstruction Cyanosis Peripheral oedema Polycythemia Stopped smoking gt 3 months Pulmonary rehabilitation If still smoking Optimise therapy Refer to Smoking Consider differential Cessation diagnosis Refer Respiratory Clinician for assessment Arterial blood gas analysis Carboxyhaemoglobin Assess risk factors safety issues Social Circumstances If PaO lt 7 3Pa or 7 3 8 0 kPa additional risk factors Recheck arterial blood gases 2 3 weeks If Pa0 8 0 kPa no additional YES risk factors If criteria met order LTOT NO Respiratory Nurse Specialist follow up approx 2 weeks Not for LTOT at present time Post delivery Add to LTOT Register Re refer if deteriorates Oxygen Alert Card as appropriate BORDERLINE Prescribe Oxygen If ABG borderline co morbidities Using Form but no risk factors discuss with Respiratory Physicians a decision will be made on clinical grounds 21 Appendix 3 ADULT AMBULATORY OXYGEN ASS
18. ers morbidity and mortality benefit in hypoxaemic patients with Chronic Obstructive Pulmonary Disease COPD e This document supports best practice for home oxygen provision by NHS Boards in Scotland 3 0 CLINICAL INDICATIONS There is no evidence of benefit from oxygen therapy in the absence of hypoxaemia Hypoxaemia may be due to a number of chronic mainly respiratory conditions the most common in Scotland is COPD DOMICILIARY OXYGEN THERAPY NATIONAL GUIDANCE 3 4 Contraindications In general provision of home oxygen therapy for treatment of chronic hypoxaemia without distressing symptomatic breathlessness should not occur in smokers risks in these situations where oxygen is being provided for prognostic purposes are such that it is difficult to justify such provision Death and serious injury to both the patient and others does occur where individuals continue to smoke in the presence of oxygen In patients who remain distressingly symptomatic with breathlessness which is relieved by provision of oxygen yet continue to smoke despite maximal effort at smoking cessation it may be necessary to assess the risk benefit of oxygen provision discussing this with the patient family and carers In general oxygen should not be provided in these circumstances unless the patient and carers are aware of and clearly motivated to minimise the potential risks and the evidence of symptomatic benefit is compelling Individual risk assessment
19. gh Flow Portable Homefill Liquid Oxygen BabyOx Portable Cylinder Concentrator Concentrator Concentrator System with Conserver Benefits Reliable No Overcomes the Can operate from Unlimited supply of Very portable Convenient Conservers can be need for regular problem of high mains battery or portable oxygen Suitable for package of used with existing oxygen flows gt 5 L m 12 v supply Lightweight long providing high portable cylinders deliveries Allows where more than Battery lasts for duration with continuous equipment Cost benefit with using a degree of one concentrator 2 5 Hrs O 2 L m integral conserver flows Silent supplied by a conserver Can be freedom about is required recharge time 1 4 Inexpensive Easy operation single provider used as a means to house 5 Ohrs to use Portable unit fills Can provide a provide higher flows depending on quickly range of low when cylinders are setting flows Lightweight restricted to 4 L m cylinders Limitations Requires Power Noisier heavier Continuous flow Home based Not suitable for Requires regular Can be noisy in some Some patients have a problem with noise Limited to 5 l m Moveable but not transportable and slightly bigger but still better than two machines Consumes more power but is reimbursed at a higher level limited to 3 0 L m If used on Pulse dose requires assessment by trained health professional Transportable not portable
20. haemia nocturnal hypoxaemia oxygen saturation of arterial blood SaO lt 9096 for more than 309 of time peripheral oedema cor pulmonale pulmonary hypertension Assess the need for oxygen therapy in adults with any of the following oxygen saturation lt 92 breathing air at rest when stable very severe airflow obstruction FEV lt 30 predicted cyanosis secondary polycythaemia raised jugular venous pressure peripheral oedema associated with signs of COPD Consider assessment for people with severe airflow obstruction FEV 30 49 predicted particularly if there is evidence of right heart failure Assessment for LTOT should comprise measurement of arterial blood gases on two occasions at least 3 weeks apart in adult patients who have a confirmed diagnosis who are receiving optimum medical management and are Clinically stable DOMICILIARY OXYGEN THERAPY NATIONAL GUIDANCE Caution Inappropriate oxygen therapy in some people with COPD may precipitate hypercapnia and respiratory depression Patients who are hypercapnic or have had an episode of hypercapnic respiratory failure should be issued with an oxygen alert card In the acute setting including out of hospital oxygen should be titrated to a target oxygen saturation of 88 9296 pending arterial gas assessment for these patients They may be provided with a venturi mask to assist delivery of controlled supplemental oxygen For chronic non emergency situations
21. ice searches via IT System who will conduct searches Community pharmacy records of who is receiving cylinder oxygen 4 Identify high users of cylinder oxygen and review them first with a view to moving to appropriate delivery system or stopping oxygen in some cases 27 5 Measurement of review outcomes numbers changed to LTOT home fill oxygen stopped and prescribing costs 6 Patient experience outcomes 7 Communication strategy to cover all of above and changes to services Suggested Service Requirements Skills Competences The assessment process should be carried out supervised by a Band 7 health professional with a suitable clinical qualification He she should have appropriate administrative support and operate within a clear clinical accountability structure The health professional should have knowledge of other conditions causing hypoxaemia Premises The assessment should take place within premises that are in accordance with appropriate physiology testing facilities especially with respect to infection control risk assessment and health amp safety policy and are spacious enough to allow for the patient s capacity for exercise to be assessed safely when assessment of ambulatory oxygen requirement is performed Co location with other diagnostic facilities e g chest x ray labs would be advantageous The assessment can also be carried out in the patient s own place of residence provided that infection con
22. ion given to removal of supplemental oxygen see section 3 1 DOMICILIARY OXYGEN THERAPY NATIONAL GUIDANCE 5 4 Change of Oxygen Prescription In the event that a patient s prescription should change in any respect HFS should be advised in order that the records may be changed and the service provider notified This should be done by completing and submitting a further SHOOF 6 0 PAEDIATRIC OXYGEN SERVICES Guidelines for home oxygen therapy for children have been published by the British Thoracic Society and present the evidence base for the practice of administering supplemental oxygen to children outside hospital and provide a useful benchmark for local service implementation Oxygen in children should only be commenced by an appropriately trained paediatrician neonatologist or cardiologist e The commonest indication for the prescription of home oxygen in childhood is chronic neonatal lung disease CNLD formerly termed bronchopulmonary dysplasia that follows preterm birth e The target oxygen saturation depends on the condition being treated and the symptoms in older children and should be determined by the paediatric consultant responsible for prescribing long term oxygen and monitored regularly e The decision to prescribe long term oxygen for a child must take account of the aetiology persistence and potential adverse effect of hypoxaemia e n most cases oximetry is acceptable as a non invasive indication of arterial o
23. ive care 19 Other primary respiratory disorder 9 Non pulmonary palliative care 20 Other specify 10 Chest wall disease 21 Not known 11 Neuromuscular disease 16 Modality Recommendation for Ambulatory Oxygen Supply Flow rate 2Il m 2i m 22 I m lt 4l m 4l m 5l m gt 5l m Oxygen Usage lt 0 5 hr day Oylinder only Oylinder only Oylinder Only Homefill Homefill Homefill lox gt 0 5hr day lt 1hr day Cylinder only oe i le jon bm 1hr day lt 2hr day Oylinder only Conserver Homefill Homefill Homefill Homefill lox Cylinder only gt 2hr day lt 3hr day Conserver Homefill Homefill Cylinder only 3 hr day Conserver Homefill Homefill Homefill Lox Homefill Lox For Lox Homefill Transportable concentrator may also be appropriate if available 17 Comments Other Useful Information 30 Appendix 8 Patient Scenarios Scenario No Patient Situation Time Current Supply Route Revised Supply Route Expected Comment Of Day Action Action Response Times Outpatient attending hospital for Anytime Concentrator provided No change 4 working days unless Improved from 5 working 1 respiratory assessment and through HFS urgent days prescribed a concentrator COPD Inpatient awaiting Anytime Concentrator provided No change 4 Working days Unless Improved from 5 working discharge and prescribed a through HFS urgent Urgent request days Urgent 2 Working 2 concentrator 2 working days days Emerge
24. m increments continuous 2 0 1 0 L m increments equivalent of 0 5 L m 0 1 1 0 L m in 3 5 6 0 L m in L m continuous or increments 8 0 L m in 5 L m 0 05 L m 0 5 increments 0 5 0 in pulse 1 5 4 0in 0 5 0 01 0 1 L min increments increments or mode from L m increments 0 01 inc 1 0 L m B 0 125 2 0 in cylinder on Demand 0 125 L m mode using in increments built conserver Social Can create Can be useful in May provide Only suitable for Primarily for Will extend the time Considerations dependency on small homes Portable O2 for suitable alternative Ground floor babies available from a equipment where space isa patients who use to Lox for those premises with Lightweight cylinder by a factor of premium and second home or patients who live in no more than 3 cylinder usually 2 3 times allowing Electricity costs where high flow stay with relatives flats or tenements steps because carried by patients to leave refunded by NHS 3 5 p per hour is required a lot or for those who go out in car and use their car as a base Portable O2 for patients based mainly from a single home rather than from car or some other temporary address of large base unit parents or placed on tray underneath pram Also used by some adults on low flows house for longer and become more active 23 Appendix 4 Equipment Specifications Attribute Regular Oxygen Hi
25. mation or visit www chss org uk 16 3 4 Holiday Supplies A patient or by proxy their Carer or Health Care Professional HCP may request a short term supply of oxygen for use on holiday within the U K Provided that they require oxygen modalities that are included in their original Oxy One form and their flow rate has not changed this supply can be made without requiring a new Oxy One prescription to be completed However should an alternative modality be requested or a change in flow rate a new Oxy One should be completed by a HCP and sent to HFS Please see the chart overleaf to clarify the process The patient should e Provide full details of the temporary address e Provide the dates for which they require the equipment e Confirm that they have obtained permission of the owner of the property to allow the use of the equipment This is particularly relevant if Lox has been requested e Obtain permission from the owner to have the equipment delivered before their arrival and have it collected after their departure e CHSS produce a fact sheet Holidays which has been compiled to provide patients and their family or carer s with some useful contacts to help to arrange a well deserved break Some organisations will make all arrangements including travel and assistance others will just take bookings for their own accommodation 16 3 5 Travelling with Portable Oxygen Cylinders Patients requiring portable oxygen cylinders fo
26. ncy 8 hrs Inpatient awaiting urgent Office Prescription for Cylinders Using hospital based Hospital own timescales Preference should be for discharge from hospital and Hours through Community concentrator or Emergency or 8 hours through HFS ESD staff to use hospital prescribed a concentrator 9 5 Pharmacy or discharge Request Through HFS based concentrators using hospital based held by RNS or concentrator by ESD staff Palliative care teams Note Provision of 3 Cylinders through Community Pharmacy is currently problematic New supply should improve on existing arrangements COPD Patient presents at A amp E Office Prescription for Cylinders Hospital respiratory team use Hospital own timescales with exacerbation and hypoxia but Hours through Community hospital based concentrators or 8 hours through HFS 4 does not need admitted Needs full 9 5 Pharmacy or emergency service respiratory assessment when through HFS stable COPD Patient presents at A amp E Prescription for Cylinders Hospital respiratory team use Hospital own timescales with exacerbation and hypoxia but Out of through Community hospital based concentrators or OOH response time 5 does not need admitted Needs full Hoi Pharmacy or OOH service respiratory assessment when stable COPD patient presents to GP with Office Prescription for Cylinders Referred to secondary care 6 exacerbation and hypoxia Hours through Community for assessment admission 9 5 Pharmacy
27. ndicated 9 0 OXYGEN DELIVERY METHODS Please see Oxygen Modality Summary Assessment in Appendix 4 10 0 MONITORING AND REVIEW OF PATIENTS ON HOME OXYGEN All patients prescribed LTOT and or AO should receive periodic review from an appropriately trained clinician Patients who have recently commenced home oxygen therapy should be reviewed within 4 weeks and thereafter at least annually A recommended oxygen review may consist of e Clinical history and examination with particular reference to symptoms Medication review including inhaler technique when applicable Pulse oximetry Arterial Capillary blood gas where clinically indicated Review of flow rate of prescribed oxygen Oxygen modality used Hours of use of oxygen per day Spirometry where indicated Smoking status including passive smoking Immunisation status Anticipatory care planning including a resuscitation plan and documentation of discussion 10 DOMICILIARY OXYGEN THERAPY NATIONAL GUIDANCE 11 0 OUT OF HOURS OXYGEN SERVICE e There is no place for initiating long term home oxygen therapy in an OUT of HOURS setting e There may be a place for short term oxygen therapy in acute situations for patients with COPD exacerbations who are hypoxaemic when oxygen saturations are measured and oxygen stopped after the acute episode is settled This should apply to hospital at home services i e provision of supplemental Os plus other therapy to permit ESD or avoid admission
28. ness days lt 2 business days 8 hours DOMICILIARY OXYGEN THERAPY NATIONAL GUIDANCE Timescales applicable for Orders received during office hours Activity Type Definition Items Time applicable between receipt and action of request Emergency Callouts During and Any breakdown situation or request All lt 8 outside office hours requiring immediate response hours Heath Facilities Scotland office hours are Monday Thursday 0900 1700 Friday 0900 1600 They are closed on Bank Holidays Note that emergency responses are not affected by Bank Holidays Notes 1 Reductions to this timescale may be made subject to due discussion and prior arrangement 2 At present HFS are unable to process requests received outside office hours or Bank Holidays However where a SHOOF is received in the days prior to a public holiday HFS will use all reasonable endeavours to provide and complete the supply as soon as possible 3 Emergency non scheduled requests for deliveries of Lox to existing customers will be handled on a case by case basis with due regards to individual circumstances 4 The emergency callout service is available 24 hours day 365 days year Servicing of Oxygen Concentrators Concentrators will be serviced every three months The date will be mutually agreed with the customer The risk assessment process is repeated at every visit 12 DOMICILIARY OXYGEN THERAPY NATIONAL GUIDANCE 14 0 OXYGEN AND P
29. r their holiday travel should be provided with a supply of cylinders sufficient to last the outward and return journeys http www healthcareimprovementscotland org home aspx 17 DOMICILIARY OXYGEN THERAPY NATIONAL GUIDANCE 17 0 CLINICAL COMPETENCE SKILLS FOR OXYGEN ASSESSMENT Competence requirements for the workforce who will carry out oxygen assessment prescribing and follow up services e Undertake clinical assessment history and examination of respiratory disease together with measurement and interpretation of spirometry Estimation and interpretation of oxygen saturation using pulse oximetry Competent to perform and interpret arterial and capillary blood gases Safe and effective administration of oxygen therapy Assess response to oxygen therapy Safe and effective prescribing of oxygen and delivery devices Providing advice and guidance to individuals carers on safe and effective oxygen therapy Assessment of risk involved in the provision of oxygen e The necessary skills and competencies are likely to be shared among the local team responsible for oxygen therapy supervision and guidance recommends identification of key responsibilities and accountability 18 0 DATA PROTECTION The Oxygen Therapy Service relies on the participation of third parties for effective management of its operations The patient should be advised that e t may be necessary to pass their details to other professionals directly involved in the pro
30. riateness of current prescription and delivery device optimisation of medication medical therapy self management and anticipatory care planning Oxygen concentrators should be used to provide the fixed supply at home for LTOT Liquid oxygen may be prescribed in some cases generally provision of high flow ambulatory oxygen for the small minority of patients in a position to benefit from this following specialist clinical and risk assessment 5 3 Oxygen Prescription DOMICILIARY OXYGEN THERAPY NATIONAL GUIDANCE e Each NHS Respiratory MCN should define who will prescribe LTOT in their Health Authority e Delegated prescribing individuals should also be identified e The Scottish Home Oxygen Order Form SHOOF Appendix 7 should be completed and faxed to HFS 5 3 1 Adults LTOT for adults with a confirmed diagnosis should only be prescribed following assessment by an appropriately trained respiratory clinician 5 3 2 Children Home oxygen for children should only be prescribed following assessment by a paediatrician neonatologist or cardiologist 5 3 3 Oxygen and Chronic Respiratory Disease Palliative care situations local solutions will need to be developed for each Health Board e g some palliative care teams will have access to portable concentrators Some boards may choose to have oxygen concentrators cylinders placed in cottage hospitals Oxygen can be delivered within 8 hours in an emergency situation via the national se
31. rvice See section 14 for further guidance 5 3 4 Oxygen and Acute Respiratory Situations e There is no place for prescribing long term home oxygen therapy to acutely ill hypoxaemic patients in primary care They should be referred for full assessment when clinically stable e Prescribing emergency home oxygen therapy to acutely ill hypoxaemic patients in primary care should only be considered where there are established Hospital at Home Prevention of Admission services and prescribing decisions are made by suitably qualified clinicians who are identified as delegated prescribing individuals Appropriate review arrangements must be in place e Patient safety in acute situations should always be considered and discussion with secondary care should be considered in hypoxaemic individuals as they may warrant further discussion assessment in secondary care DOMICILIARY OXYGEN THERAPY NATIONAL GUIDANCE 5 3 5 Oxygen and Cluster Headache Oxygen may be prescribed for the acute treatment of cluster headache attacks high flow oxygen with a flow of at least 10 l min over 15 min via non rebreather mask for 10 20 minutes This should only be initiated after consultation with a neurologist Discussion with a respiratory specialist should be considered before administering high flow oxygen to patients with COPD with known hypercapnoea who have cluster headache 5 3 6 Prescribing Considerations When prescribing oxygen therapy of any modality
32. ry case conference may identify additional support or training that ensures appropriate remedial action If there is persistent failure to ensure the child s health needs are being met then child protection referral may be justified When an infant or child has been assessed as no longer requiring supplementary oxygen on a daily basis the oxygen supply is generally left in the home until confirmation that the child can cope in air during risk periods such as acute respiratory infections 13 DOMICILIARY OXYGEN THERAPY NATIONAL GUIDANCE 16 0 USING OXYGEN THERAPY Practical issues for prescribers oxygen provider and users to consider 16 1 Safe Storage and use of Oxygen Equipment and Car Insurance 16 1 1 Fire Risks Consequences of oxygen enrichment e Materials which are not flammable in air may ignite and or burn in higher concentrations of oxygen e Materials which will burn in air will burn ignite at lower temperatures if the oxygen concentration is elevated 16 1 2 Prevention Avoid oxygen enrichment by e Turning off the equipment when not in use e Not permitting oxygen to accumulate on absorbent materials such as clothing bedding furniture e Keeping the user environment well ventilated 16 1 3 Flammable Materials Do not let oxygen equipment come into contact with oils or grease paraffin based products and NEVER use any form of lubricant ignition is a greater risk in an oxygen enriched environment e Do not use or s
33. sed clinics Other Oxygen Supply Situations Time Of Day Current Supply Route Action Could be BOC directly secondary care supply through Air Liquid hospital cylinder gas contract or supply through Pharmacy Anytime Revised Supply Route Action If BOC direct or through hospital gas contract then existing arrangement should apply If through pharmacy then discussion agreement needed with BOC CPS Expected Response Times Existing response time or 4 days 2 days or 8 hours Comment 12 Emergency CD cylinder for GP bag Could be BOC directly or supply through Pharmacy Anytime If BOC directly then existing arrangement should apply If through pharmacy then discussion agreement needed with BOC CPS Existing response time or 4 days 2 days or 8 hours GPs are currently likely to make private purchase of cylinder from pharmacy They receive allowance from Boards for equipment and supplies for this Board funding could be re negotiated This could be significant as there are around 1000 GP practices across the country 13 Community Hospitals without Piped Medical Gas Could be BOC directly or supply through Pharmacy or through hospital cylinder contract Anytime If BOC direct or through hospital gas contract then existing arrangement should apply If through pharmacy then discussion agreement needed with BOC CPS Consideration should
34. should be undertaken and clearly documented in such circumstances Children receiving oxygen should not be exposed to tobacco smoke and parental carer smoking must be strongly discouraged 4 0 PRIMARY CARE PATHWAY 4 1 Primary Care Oxygen Assessment Referral Criteria Referral in adults should be based on e Confirmed diagnosis of the cause of the hypoxaemia and the patient is in a stable condition e Patients with COPD other respiratory conditions in the absence of an exacerbation in the last 4 weeks and needs to have an O saturation of lt 9296 on breathing air Please see quick guide in Appendix 1 DOMICILIARY OXYGEN THERAPY NATIONAL GUIDANCE 5 0 SECONDARY CARE PATHWAY 5 1 Long Term Oxygen Therapy LTOT Please see LTOT Assessment Flowchart in Appendix 2 COPD Clinical conditions that may be referred for oxygen assessment e Known Chronic Hypoxaemia lt 92 SaO at rest COPD approx 7096 of patients Interstitial lung disease Pulmonary vascular disease including pulmonary hypertension Nocturnal hypoventilation as adjunct to ventilatory support techniques NIV or CPAP Severe chronic asthma Neuromuscular spinal chest wall disease Cystic fibrosis Bronchiectasis Pulmonary malignancy Chronic heart failure Chronic neonatal lung disease LTOT is indicated in non smoking patients with COPD if e PaQz is lt 7 3 kPa when clinically stable e PaO between 7 3 and 8 kPa when stable and secondary polycyt
35. ssessment Service Hospital or Clinical Service 6 Ward Details if applicable 5 1 Hospital or Clinic Name 6 1 Name 5 2 Address 6 2 Tel No 6 3 Discharge Date 5 3 Postcode 5 4 Telephone No 7 Respiratory Contact 7 1 Name 7 2 Tel No 7 3 Mobile 8 Order 9 Equipment For further guidance on choosing modalities please see reverse of form 10 Consumables tick selection for each equipment type Litres Min Hours Day Types Nasal Medium Cannula Concentration Mask 9 1 Static Concentrator with back up cylinder s Should be prescribed for use gt 1 5hrs day 9 2 Static Cylinder s Should be prescribed for use 1 5hrs day 9 3 Standard Ambulatory Cylinder s Low flow low usage occasional ambulatory needs 9 4 Standard Ambulatory Cylinder s amp Conserver Medium flow high usage active patients Specialist high usage ambulatory equipment Please check with HFS for availability before ordering 9 5 Home filling Concentrator System Should be prescribed for high usage active patients 9 6 Liquid Oxygen LOX Dewar amp Flask Specialist use high flow amp very active patients or when other modalities not appropriate LO JOJO E 9 7 Portable Concentrator trolley based Specialist use temporary locations active patients LO Oy OOOO L 11 Additional Equipment 11 1 Humidification not usually indicated for lt 4l min Yes No 10 2 Tracheo
36. stomy mask only Yes No 12 Delivery Details 29 12 1 Standard 4 business days L 12 2 Urgent Palliative 2 business days 12 3 Emergency 8 hours 13 Additional Patient Important Information 14 Healthcare Professional Declaration declare that the information given on this form for NHS treatment is correct and complete understand that if knowingly provide false information may be liable to prosecution or civil proceedings confirm that am the registered healthcare professional responsible for the information provided confirm that the appropriate consents have been granted for providing this information and that the patient has been advised that their details will be passed to Electricity Distributors and Fire Service Name Profession Signature Date Fax back number or NHS email for queries corrections 15 Clinical Codes please insert relevant codes over page in section 4 1 Code Condition Code Condition 1 Chronic obstructive pulmonary disease COPD 12 Neurodisability 2 Pulmonary vascular disease 13 Obstructive sleep apnoea syndrome 3 Severe chronic asthma 14 Chronic heart failure 4 Interstitial lung disease 15 Paediatric interstitial lung disease 5 Cystic fibrosis 16 Chronic neonatal lung disease 6 Bronchiectasis not cystic fibrosis 17 Paediatric cardiac disease 7 Pulmonary malignancy 18 Cluster headache 8 Palliat
37. tore near any flammable oily materials e Do not cover or wipe the equipment with any fibrous material e Protect the equipment by carrying storing and using in approved carry cases only where provided e Wash and dry hands thoroughly before handling any oxygen equipment e Do notuse or store the equipment within three metres of Naked flames Sources of intense heat e g cooker hobs ovens heaters etc e Do not smoke or let others smoke near anyone while using oxygen This not only presents a fire risk but is seriously detrimental to health e The customer should be advised that the fire brigade will be provided with their details to Place on record the fact they have Oxygen equipment Conduct a risk assessment fit smoke alarms where appropriate 16 1 4 Physical Safety Avoid the risks of tripping over or blocking the supply tubing by e Keeping the tubing as short as is practicable however longer tubing to allow mobility within the home may be considered following risk assessment e Using a fixed install where appropriate Responsible adults must be vigilant that other children and any animals are supervised when in the vicinity of the child on oxygen as the risk of injury exists for all 14 DOMICILIARY OXYGEN THERAPY NATIONAL GUIDANCE 16 1 5 Carrying Transporting Equipment e Use only approved devices for carriage and transport e Secure items in transit so they are not free to move 16 1 6 Toppling Over e Ensure items
38. trol risk assessment and health and safety policy are adhered to Equipment The assessment requires measurement of arterial capillary blood gases as well as oximetry and spirometry and such equipment properly maintained must be available In addition a variety of oxygen equipment both for LTOT and ambulatory use must be available in order to assess the patient and ensure they are given the most appropriate equipment for their needs 28 Appendix 7 Scottish Home Oxygen Order Form SHOOF After specialist paediatric oxygen assessment NHS National Services Scotland All fields marked with a are mandatory and the HOOF will be rejected if not completed 1 Patient Details 1 1 CHI Number 1 2 Hosp Number 1 8 Permanent Address 1 11 Tel No 1 3 Title 1 12 Mobile No 1 4 Surname 1 13 E Mail 1 5 First Name 1 14 1 Language if not English 1 6 DOB 1 9 Postcode 1 7 Gender Male lFemale 1 10 Funding Health board 1 15 Interpreter needed Yes NoL 2 Carer Details if applicable 2 1 Name 2 2 Tel No 2 3 Mobile No 3 Clinical Details clinical codes see over 4 Patient s Registered GP Information 3 1 Clinical Code s 4 1 Main Practice Name 3 2 Patient on NIV CPAP Yes No 42 Practice Address 3 3 Paediatric Order Yes No 3 4 Conserver Appropriate Yes _ No L 4 3 Postcode 4 4 Telephone No 5 A
39. ts Appendix 7 Scottish Home Oxygen Order 29 Form SHOOF Appendix 8 Patient Scenarios 31 DOMICILIARY OXYGEN THERAPY NATIONAL GUIDANCE 1 0 EXECUTIVE SUMMARY This document has been developed by a subgroup of the National Advisory Group NAG for Respiratory Managed Clinical Networks MCNs in NHS Scotland along with a broad range of stakeholders from the British Lung Foundation BLF Chest Heart and Stroke Scotland CHSS Scottish Government Health Directorates SGHD NHS Respiratory Clinicians Primary Care General Practitioners and Health Facilities Scotland HFS This guidance reflects current good practice in the assessment review and delivery of home oxygen services and sets out the core components of a high quality assessment and review service for home oxygen It is aimed at all clinicians and stakeholders who may encounter people who are using home oxygen services and those requiring assessment for consideration of this therapy in the future 2 0 INTRODUCTION e Oxygen is a drug e Oxygen requires a prescription e Oxygen is a treatment for hypoxaemia Oxygen may be of symptomatic benefit in breathlessness in the presence of hypoxaemia Significant hypoxaemia in adults requiring consideration of treatment is conventionally defined as PaO lt 8kPa SpO lt 92 in room air e Oxygen has no benefit on the symptom of breathlessness in non hypoxaemic patients e Long term supplemental oxygen off
40. vision of their healthcare and preservation of their safety e Personal information will NOT be passed to others who do not have a legitimate interest in their healthcare or their safety e Typical agencies involved in this process include but are not restricted to Health Facilities Scotland Dolby Vivisol the current service provider The client s electricity provider in case of power failure in adverse weather conditions The local Fire and Rescue authority Child Care and Education staff Note This is a requirement under the data protection act and is not to be confused with gaining informed consent for treatment 18 DOMICILIARY OXYGEN THERAPY NATIONAL GUIDANCE 19 0 ALTERATION TO EXISTING SERVICES A suggested oxygen review toolkit model to assist NHS Boards moving forward with their oxygen review for adults is included as Appendix 6 In addition a summary of the various scenarios in which patients may receive oxygen is included as Appendix 8 The summary sets out the existing supply mechanism and details how this would be addressed under the new arrangements 20 0 REFERENCES 1 BMJ Group and Pharmaceutical Press 2011 British National Formulary 61 National Clinical Guideline Centre 2010 Chronic Obstructive Pulmonary Disease Management of chronic obstructive pulmonary disease in adults in primary and secondary care London National Clinical Guideline Centre British Thoracic Society Guidelines for Home
41. xygenation but arterial or capillary blood gases should be recorded if there is a need to assess any sign of respiratory failure e Most infants on home LTOT require low flow oxygen by nasal prongs throughout the 24 hours This generally involves an oxygen concentrator with low flow meter in the home and a portable oxygen supply that can be carried by the parent guardian or used in a nursery setting during the day e For those requiring high oxygen flow rates liquid oxygen LOX may be preferable with a humidifier and portable high capacity cylinders for ambulatory use See Appendix 4 for options to address specific therapy requirements DOMICILIARY OXYGEN THERAPY NATIONAL GUIDANCE 7 0 AMBULATORY OXYGEN Clinical Indications and Patient Assessment Protocol for Ambulatory Oxygen Therapy AO Please see Appendix 3 Clinical indications for AO 7 1 Existing Domiciliary Oxygen Therapy DOT Service Users AO may be offered to people already using LTOT who need to use oxygen outside the home following assessment by a respiratory clinician However in breathless patients with COPD who do not have severe resting hypoxaemia there is little evidence to support the benefits of AO AO is likely to be required for all infants and most children receiving LTOT 7 2 Ambulatory Oxygen Therapy for Patients who Desaturate on Exercise not on LTOT Individuals who have a diagnosis of COPD or other established conditions e g interstitial lung
42. y Oxygen for Adults Newcastle PCT It is felt that there will be two distinct groups of patients that differ greatly i e those patients who will be amenable to having oxygen withdrawn if there is no continued clinical need and those who will not be willing to have oxygen withdrawn The protocol therefore will have to be adapted for those patients who are not willing to have their oxygen withdrawn compared to those who would be willing At present if the patient s resting oxygen saturations are persistently above 94 SpOz breathing room air then it is considered safe for oxygen to be withdrawn Suggested process Visit one Full annual review if SpO is gt 94 after 15 minutes without oxygen the patient will require further assessment in 1 2 weeks Visit two 1 2 52 Patients will be asked to remove oxygen one hour prior to the visit if a home visit and to sit for one hour without oxygen if attending a clinic If SoO2 remains above 9495 after one hour without oxygen the patient will require a further assessment Visit three 1 2 52 There may be a requirement for further assessment in complex cases As part of the annual review process each patient will be assessed as to their continued suitability for oxygen use In the future it is planned that all new referrals for LTOT and ambulatory oxygen will have initial screening carried out by the Nurse Led Oxygen Assessment Service 26 Appendix 6 Suggested Oxygen review toolkit
43. ygen equipment whilst the vehicle is being refuelled 15 DOMICILIARY OXYGEN THERAPY NATIONAL GUIDANCE 16 2 5 Prescription and Flow Rates The patient should be advised not to change their prescription without consulting their clinician Finally if the patient is at risk from high flow rates of oxygen they should be issued with an Oxygen Alert Card by a respiratory clinician and carry it with them at all times This can be downloaded free of charge from http www brit thoracic org uk 16 3 Holidays Air Travel Insurance 16 3 1 Travel Insurance Basic travel agent holiday insurance may not be able to provide adequate cover for people with existing medical conditions More specialised insurance policies are more suitable It is worth shopping around for the best deals It is important to check exactly what your cover will provide See the Chest Heart Stroke Scotland fact sheet Sympathetic Insurance Companies for more information 16 3 2 Air Travel and Oxygen Therapy There is a wide variation between different airlines in the terms and conditions under which oxygen may be carried and used It is the customer s responsibility to make arrangements not only for in flight provision but also for transit and transfers within the airport s and on to the plane s There are several private oxygen providers who can facilitate this however the costs must be met by the traveller as no provision for this service is made within the N
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