Josie McCabe

Josie McCabe is an advanced trainee in Respiratory and sleep medicine and general medicine. Originally from Shrewsbury, England (home of the famous biscuits and Charles Darwin). Studied at University of Sheffield and completed MRCP (UK) before moving to NZ in 2012.
Worked in Tauranga then Christchurch for 6 1/2 years. Moved to Auckland December 2019 to experience more traffic, volcanoes, pohutakawas and training in sleep medicine.

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Electronic Prescription Template Doubles Rates Of Oxygen Prescribing

Aims: To establish if oxygen is administered according to Thoracic Society of Australia and New Zealand (TSANZ) guidelines (Beasley, 2015) on Acute Medical Assessment Unit (AMAU).
To assess effect of introducing an electronic oxygen prescription template on prescribing rates.

Methods: In March (round 1) and October-November 2019 (round 2) investigators audited over 4 week periods. All bed spaces on AMAU were visualised to document occupancy and oxygen supplementation. For patients receiving oxygen current admission notes, observations and prescription charts were inspected.

Results: In round 1, 62/805 audited patients (7.7%) were on oxygen, 73/821 (8.8%) in round 2.
Oxygen was administered to treat hypoxia in 106/134 (79.1%) of cases indicated by lowest documented saturations <92%. Evidence of oxygen titration was seen with median last recorded saturations averaging lower in both rounds (95% and 94%) than highest recorded saturations (97% and 96%).
Oxygen prescription rates increased from 18% (11/61) on paper prescription to 38% (28/73) after introduction of electronic prescription template.

Conclusions: Electronic template more than doubled prescribing, however most oxygen supplementation is not prescribed. Oxygen is generally administered in line with TSANZ guidelines despite low prescribing levels. System changes are required to ensure supplemental oxygen is used appropriately for every patient to minimise harm from hyperoxygenation, which is shown to increase mortality (Chu, 2018).

References: 
Beasley R, Chien J, Douglas J, Eastlake L, Farah C, King G, et al. Thoracic Society of Australia and New Zealand oxygen guidelines for acute oxygen use in adults: 'Swimming between the flags'. Respirology. 2015;20(8):1182-91.
Chu DK, Kim LH, Young PJ, Zamiri N, Almenawer SA, Jaeschke R, et al. Mortality and morbidity in acutely ill adults treated with liberal versus conservative oxygen therapy (IOTA): a systematic review and meta-analysis. Lancet. 2018;391(10131):1693-705.