Bethany Stoneham

Originally from Bath, England (home of the Roman Baths and Jane Austen), trained at University of Sheffield graduating in 2017. I moved to NZ in August 2020 during the global covid-19 pandemic. I currently work in Christchurch Hospital & hope to become a respiratory physician. This project was initiated by Dr Josie McCabe in 2019 and presented orally here last year. We have completed a third cycle in 2020 to close the loop.

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A Closed Loop Audit Of Oxygen Prescribing In Patients Admitted Under General Medicine At Christchurch Hospital: An Electronic Prescription Template Doubles Rates Of Oxygen Prescribing

Aims:
To evaluate oxygen prescribing in General Medicine at Christchurch Hospital for the treatment of hypoxia. Further, to audit the safety and accuracy of oxygen prescription using ‘swimming between the flags’ (TSANZ) oxygen prescribing guidelines as the reference standard. 

Methods: 
Three audit cycles between March 2019 and January 2021 were carried out, analyzing patients admitted acutely under General Medicine. Patients and their notes were reviewed to gather data on demographics, oxygen saturations, and prescriptions. The second cycle audited the response to an electronic oxygen prescription template after one month. The third cycle was performed a year later after the opening of a new hospital building and the rotation of junior doctors.
 
Results: 
2405 occupied beds were audited over three cycles with a total of 205 patients on oxygen (8.5%). In all three audits low flow nasal cannulae were the commonest oxygen delivery device in use (83.9%). In cycle 2 following the intervention of an electronic oxygen prescription template, oxygen prescription increased significantly from 18% to 38% (p=0.013). This was maintained in cycle 3 at 38%. The trend in all audit cycles demonstrated evidence of titration with oxygen therapy mostly being used to keep patients between 92-96% target. In chronic obstructive pulmonary disease (COPD) patients, oxygen saturations trended higher than the recommended 88-92%, and only 46.8% had last recorded saturations within target range. 
 
Conclusion:
The intervention was to provide prescribers with pre-formatted electronic prescribing templates providing oxygen ranges including lower and upper limits of oxygenation. This simple change led within 1­­­­­­ month to a doubling of oxygen prescription rates and this was sustained over longer than a year. Oxygen is generally prescribed in line with TSANZ guidelines. However, prescription rates still remain low.