addenbrooke’s hospital implementation of the bts 2008 emergency oxygen guidelines – the story so...
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Addenbrooke’s Hospital Implementation of the
BTS 2008 Emergency Oxygen Guidelines
– the story so far
Caroline Owen
Respiratory Nurse Specialist
Addenbrooke’s Hospital, Cambridge
Where have we been? 1990’s – 2005 – aimed at education
2005-2008 – reviewed process – stickers in charts
2008 – BTS guidelines aimed to simplify and improve oxygen administration
2009 – NPSA alert No prescription Poor monitoring of the patient Incorrect administration – confusing air and oxygen flow
meters Equipment – empty cylinders
2010 – Addenbrooke’s guideline
2012 – Never event
2014 – E-hospital
Data Assessed
Ad’brooke
2013
National
2013Ad’brooke
2012National
2012Ad’brooke
2011Nationally2011
Ad’brooke
2010
% of patients using oxygen with a prescription with a target range
94% 55% 94% 46% 75% 48% 72%
% of signatures to drugs rounds
87% 21% 76% 20% 61% 20% 32%
% of observations to rounds
123% 100% 106% 100% 108% 100% 96%
% of patients within target range
74% 64% 78% 57% 75% 67% 61%
BTS Oxygen Audit 2013 - Summary of data collected in comparison to National data and previous data collected
Challenges Signing drug chart
Oxygen titration (audit poor to identify)
ED
Ambulance Services – ‘Alert’ cards
Surgery
Resuscitation guidelines & Oxygen guidelines
Airflow meter confusion
Air Flow Meter’s Concerns over confusing oxygen and air flow
meters
2011 audit - 384 beds checked – 106 air meters in-situ – majority not being used
STANDARD REQUIRED: Air flow meters should be taken out of the wall
when not in use Air flow meters should be kept in a dedicated
place Air flow meters need high-lighting they are air
and not oxygen
Airflow meter covers
IT’S BLACK
AND LABELLED
“AIR”A new
cover to help remind
you it is air
BEWARE! DON’T CONFUSE OXYGEN AND AIR FLOW METERS!
IT’S WHITE AND
LABELLED “O2”
AIRFLOW METERS• REMOVE WHEN NOT IN USE• KEEP IN A SPECIAL ALLOCATED PLACE IN YOUR AREA
OXYGEN FLOW METERS• KEEP IN THE WALL IN CASE OF EMERGENCIES
Electronic Hospital
Mandatory for all trusts by 2020 to be paperless
Addenbrooke’s introduced an electronic system using Epic software in October 2014
Other hospitals have chosen different software
We no longer use paper and all communication, charting and prescribing is done on the computers
Access from inside the hospital and outside; on laptops, smart phones and i-pads
E-hospital considerations for oxygen prescribing
What requirements must be fulfilled?
Highlight these early on in the design
When should oxygen be prescribed – on arrival into ED or later when patient is fully assessed?
What should it look like?
Should all patients be allocated a target saturation?
What alerts may you want to add?
E-hospital considerations for nurse administration
How should they see the oxygen prescription or order?
How frequently should they ‘sign’ for it?
Who should sign for it?
Vital sign frequency can be ‘ordered’
Which measures can be applied to improve safety?
Potential Advantages
No paper – changes can be made without altering previous charts
Better record keeping – neater! Easy access Visual reminders for doctors to write up; nurses
to sign for. If out of range – alerts staff to address Easy audit Best practice alerts
Potential Disadvantages
Adapting to a new way of working
Many screens leads to information overload
Requires good data input
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