Original Research Implementation of a multicomponent intervention to optimise patient safety through improved oxygen prescription in a rural hospital Roshan Gunathilake, MD, 1 Deborah Lowe, DipCOT, 2 James Wills, MBBS, MHA, FRACMA, 2 Anne Knight, MBBS, FRACP, 2 and Peter Braude, MBBS, FRACP 2 1 Department of General Medicine, John Hunter Hospital, New Lambton, and 2 Manning Rural Referral Hospital, Taree, New South Wales, Australia Abstract Objective: To rationalise oxygen procedures in adult medical and surgical inpatients with a view to improv- ing patient safety. Design: Prospective pre- and post-intervention audit. Setting: Manning Hospital, a rural referral hospital in Taree NSW. Participants: Pre-intervention: 82 patients aged 72.7 ± 14.7 years. Post-intervention: 77 patients aged 73.6 ± 12.4 years. Intervention: A multicomponent intervention com- posed of implementation of a local hospital oxygen policy, introduction of a specific oxygen prescription chart and targeted staff education. Main outcome measures: Satisfactory oxygen prescrip- tion, monitoring and titration. Results: Only 2/82 (2.4%) patients had satisfactory oxygen prescription specifying target saturation, device and initial flow rate before the intervention compared with 26/77 (34%) patients post-intervention (χ 2 = 56.88, df = 5, P < 0.0001). Percentage of patients with conditions predisposing to hypercapnic respiratory failure who were overtreated with oxygen dropped from 9/19 (47%) to 4/22 (18%) following the study interven- tion (χ 2 = 4.011, df = 1, P = 0.04). Oxygen therapy monitoring was satisfactory during the audit period, but oxygen titration was unsatisfactory and did not signifi- cantly improve following the intervention. Conclusions: A multicomponent intervention can achieve a significantly increased rate of satisfactory oxygen prescriptions specifying target saturation, including in those who are at risk of hypercapnic respi- ratory failure. KEY WORDS: multicomponent intervention, oxygen prescription, rural setting, safety and quality, target saturation. Introduction Inhaled oxygen therapy is commonly used in hospitalised patients. 1,2 When used appropriately, oxygen therapy can improve clinical outcomes in hypoxaemic patients. 3 While oxygen can be life-saving, hyperoxaemia is potentially harmful. 4 Hyperoxaemia was linked to reduced survival in cardiac arrest victims admitted to intensive care 5 and in subjects presenting with acute minor to moderate stroke. 6 In an observa- tional study, uncontrolled oxygen therapy increased the length of hospital stay, need for non-invasive ventila- tion, and admission to high dependency unit or intensive care unit among patients with acute exacerbations of chronic obstructive pulmonary disease (COPD). 7 Con- versely, in one randomised control trial, subjects with acute exacerbation of COPD who received titrated oxygen therapy in the prehospital setting had lower mortality compared with standard high flow oxygen. 8 Oxygen is often given without any prescription, 9 although guidelines recommend that oxygen should be prescribed specifying target saturation, device and an initial flow rate as a minimum. 10,11 A target saturation of 94–98% is appropriate for most acutely unwell patients, while a lower target range of 88–92% is recommended for those at risk of hypercapnic respiratory failure (e.g. COPD patients). 10 All patients receiving oxygen should be monitored clinically and with regular pulse oximetry, and oxygen therapy should be titrated to the target saturation. 10 There are no national guidelines on Correspondence: Dr Roshan Gunathilake, Department of General Medicine, John Hunter Hospital, Lookout Road, New Lambton, New South Wales 2305, Australia. Email: roshangun@yahoo.com All authors contributed equally to this work. Accepted for publication 4 April 2014. Aust. J. Rural Health (2014) 22, 328–333 © 2014 National Rural Health Alliance Inc. doi: 10.1111/ajr.12115