A point-prevalence audit of oxygen prescribing and monitoring practices in a tertiary teaching hospital

A Point-Prevalence Audit of Oxygen Prescribing and Monitoring Practices in a Tertiary Hospital in Dublin, Ireland Elkhidir(A.(Babikir¹,(Liam(Cormican¹( ¹(Respiratory(Medicine,(Connolly(Hospital,(Dublin,(Ireland( Corresponding(author:(Elkhidir(A.(Babikir(–([email protected]( Abstract Background Oxygen(therapy(is(one(of(the(most(common(hospital(interventions,(yet(inappropriate( prescribing(and(monitoring(can(lead(to(patient(harm,(particularly(among(those(with(chronic( respiratory(disease.(National(guidelines(from(the(British(Thoracic(Society((BTS)(and( Ireland’s(National(Clinical(Effectiveness(Committee((NCEC)(recommend(that(oxygen(be( prescribed(formally(with(a(defined,(condition-specific(target(saturation(range([1,2].(This( audit(assessed(adherence(to(these(standards(in(a(tertiary(hospital.( Methods A(point-prevalence(audit(was(conducted(at(Connolly(Hospital,(Dublin,(Ireland,(between( August(4(and(August(23,(2025.(Adult(inpatients(on(the(medical(and(respiratory(wards(who( were(receiving(supplemental(oxygen(at(the(time(of(review(were(included.(Data(were( collected(on(oxygen(prescription,(documentation(and(appropriateness(of(target(saturation( ranges,(and(alignment(of(observed(saturations(with(those(targets.(Categorical(data(were( analyzed(using(the(Chi-square(test,(or(Fisher’s(exact(test(where(expected(counts(were(<(5.( Statistical(analyses(were(performed(with(IBM(SPSS(Statistics(for(Windows,(Version(29.0( (IBM(Corp.,(Armonk,(NY,(USA).(The(audit(was(registered(with(the(Connolly(Hospital(Clinical( Audit(Department((Audit(ID(CH-QIP-2025-17).( Results A(total(of(33(patients(were(included(in(the(audit.(Table(1(presents(the(demographic(and( clinical(characteristics(of(the(study(cohort.(The(mean(age(was(68.4(±(12.3(years,(with(18( (55%)(males(and(15((45%)(females.(Most(patients(were(admitted(under(medical(wards( (55%),(and(the(average(hospital(stay(was(7.2(±(3.4(days.(The(most(common(diagnoses(were( COPD(exacerbation((33%)(and(pneumonia((27%).(Table(2(summarizes(compliance(with( oxygen-prescribing(and(monitoring(standards.(Only(3((9%)(patients(had(oxygen(formally( prescribed(on(the(medication(chart,(and(13((39%)(had(documented(target(saturation( ranges,(of(which(5((15%)(were(appropriate(for(the(clinical(context.(At(the(time(of(review,(6( (18%)(patients(were(within(the(target(range.(The(differences(between(expected((100%)(and( observed(compliance(were(statistically(significant((p(<(0.05).( Table(1.(Demographic(and(clinical(profile(of(included(patients((n(=(33)( ( Sex:(Male(18((55%),(Female(15((45%)( Age(group:(<50((15%),(50–69((42%),(≥70((42%)( Ward(type:(Medical(18((55%),(Respiratory(15((45%)( Mean(hospital(stay:(7.2(±(3.4(days( Primary(diagnosis:(COPD(exacerbation(11((33%),(Pneumonia(9((27%),(Heart(failure(5( (15%),(Asthma(3((9%),(Other((sepsis,(ILD,(etc.)(5((15%)( Table(2.(Compliance(with(oxygen-prescribing(and(monitoring(standards((n(=(33)( Parameter(|(Standard((%)(|(Observed(n((%)(|(95%(CI(|(p-value( Oxygen(formally(prescribed(|(100(|(3((9%)(|(1–24(|(0.001( Target(saturation(range(documented(|(100(|(13((39%)(|(22–58(|(0.005( Target(range(appropriate(for(context(|(100(|(5((15%)(|(5–32(|(0.02( Patients(within(target(range(|(100(|(6((18%)(|(7–35(|(0.01( P-values(calculated(using(Chi-square(test((Fisher’s(exact(applied(where(expected(counts(<5).( Discussion Interpretation of Findings This(audit(demonstrates(persistent(deficiencies(in(adherence(to(established(oxygenprescribing(standards(at(Connolly(Hospital.(Only(9%(of(patients(had(oxygen(formally( prescribed,(and(less(than(half(had(documented(target(saturation(ranges—findings( consistent(with(previous(studies([3,4].(The(low(compliance(rate(likely(reflects(systemic( factors(such(as(limited(staff(awareness,(absence(of(prompts(in(the(medication(chart,(and( misconceptions(about(the(pharmacologic(importance(of(oxygen(therapy.( Comparison with Other Studies Comparable(audits(across(the(UK(and(Ireland(have(reported(similar(deficiencies,(with( formal(oxygen-prescription(rates(typically(below(20%.(Following(implementation(of( structured(educational(interventions(and(electronic(prescribing(prompts,(compliance(in( some(centers(improved(to(over(70%,(underscoring(the(value(of(targeted(education(and( workflow(redesign([6,7].( Potential Explanations and Implications Inadequate(documentation(of(target(saturation(ranges(likely(results(from(both(human(and( system-level(barriers([1,2].(The(format(of(existing(medication(charts(may(not(prompt( clinicians(to(record(target(saturations,(and(time(constraints(contribute(to(oversight.(This(is( clinically(significant(for(patients(at(risk(of(hypercapnic(respiratory(failure,(for(whom( excessive(oxygen(administration(can(precipitate(CO₂(retention(and(acidosis.( Limitations This(was(a(single-center(audit(with(a(modest(sample(size(and(a(point-prevalence(design.( Data(collection(was(conducted(by(a(single(auditor(without(inter-rater(reliability(assessment.( Despite(these(limitations,(the(audit(provides(a(valid(snapshot(of(routine(practice(and( highlights(specific(targets(for(improvement.( Novelty and Future Work This(audit(represents(the(first(cycle(of(a(planned(two-cycle(quality-improvement(project.( Proposed(interventions(include(staff(training,(visual(reminders(on(medication(charts,(and( the(integration(of(electronic(prescribing(prompts.(A(re-audit(is(scheduled(for(Q1(2026(to( evaluate(the(impact(of(these(measures(and(close(the(audit(loop.( Conclusions Adherence(to(national(oxygen-prescribing(guidelines(remains(suboptimal(at(Connolly( Hospital.(Formal(prescriptions,(appropriate(target(documentation,(and(compliance(with( saturation(ranges(were(below(expected(standards.(Targeted(education(and(system-based( solutions(are(essential(to(align(clinical(practice(with(national(guidance(and(improve(patient( safety.( References 1.(O'Driscoll(BR,(Howard(LS,(Earis(J,(Mak(V.(BTS(guideline(for(oxygen(use(in(adults(in( healthcare(and(emergency(settings.(Thorax.(2017;72(Suppl(1):ii1–ii90.(DOI:( 10.1136/thoraxjnl-2016-209729.( 2.(Irish(Thoracic(Society.(Irish(Guidelines(on(the(Administration(of(Oxygen(Therapy(in(the( Acute(Clinical(Setting(in(Adults((Revision(No(1,(November(2017).(Irish(Thoracic(Society;( 2017.(URL:(https://irishthoracicsociety.com/wp-content/uploads/2017/12/O2Guidelines-Final.pdf((Accessed(October(2025).( 3.(Austin(MA,(Wills(KE,(Blizzard(L,(et(al.(Effect(of(high-flow(oxygen(on(mortality(in(COPD( patients(in(the(pre-hospital(setting:(randomised(controlled(trial.(BMJ.(2010;341:c5462.(DOI:( 10.1136/bmj.c5462.( 4.(Beasley(R,(Patel(M,(Perrin(K,(O'Driscoll(BR.(High-concentration(oxygen(therapy(in(COPD.( Lancet.(2011;378(9795):969-970.(DOI:(10.1016/S0140-6736(11)61431-1.( 5.(Plant(PK,(Owen(JL,(Elliott(MW.(Early(use(of(non-invasive(ventilation(for(acute(COPD( 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