POLICY FOR NON OXYGEN SPECIALIST PRIMARY CARE ORDERING OF HOME OXYGEN

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1 POLICY FOR N OXYGEN SPECIALIST PRIMARY CARE ORDERING OF HOME OXYGEN Authors: LOUISA BANFIELD KAREN GARROD Version: Draft 2 Approved: Review Date: Acknowledgements Miriam Johnson, Reader in Palliative Care & Honorary Consultant to St Catherine s Hospice, Scarborough, North Yorkshire. Andrew Innes, GP with Special Interest in Respiratory Medicine, Church View Surgery, Hedon. Mid Yorkshire NHS Hospitals NHS Trust, Policy for primary care ordering of home oxygen

2 1. AIM This is a PCT wide Primary Care Policy to enable Primary Care/ Community Services Clinicians to provide a consistent approach to the ordering of Home Oxygen Therapy. The administration of supplementary oxygen is an essential element of appropriate management for a wide range of clinical conditions and the aim of this policy is to ensure that all patients who require supplementary oxygen therapy receive oxygen that is appropriate to their clinical condition and in line with national guidance. The Home Oxygen Order Form (HOOF) is not a prescription (against which a charge for a drug is made), but an order form for a service and as such its completion is not restricted to prescribers and it may be signed off by any registered healthcare professional. However, failure to administer and monitor oxygen therapy appropriately can be of detriment to a patient. Therefore the provision of oxygen therapy to all groups other than palliative patients should be initiated by Specialist teams. This policy is aware of current and future research within the area of home oxygen therapy. It is therefore appropriate for patients to be initiated on home oxygen beyond the recommendations of this policy for the purposes of research. 2. INITIATING HOME OXYGEN THERAPY FOR PALLIATIVE CARE PATIENTS WHERE CLINICALLY APPROPRIATE 2.1 For the purpose of this document, the definition of a palliative care patient is a person with advanced disease where: AND 1. breathlessness is refractory to optimal treatment for the underlying condition 2. where the aim of oxygen therapy is to relieve symptoms such as dyspnoea and confusion. 2.2 As a general rule, primary care clinicians should only initiate home oxygen for short burst oxygen therapy (SBOT) (e.g. for minutes) to relieve dyspnoea and/ or confusion in palliative care patients whose SpO2 92% measured via pulse oximetry. 2.3 In patients with breathlessness who are normo or mildly hypoxaemic, evidence suggests that oxygen therapy does not convey any additional benefit for their breathlessness over that which may be gained by the passage of air across the nasal mucosae. Referral should be made to the specialist palliative care team or Hospice services for evaluation and consideration of pharmacological and non pharmacological interventions to relieve symptoms. 2.4 NB. It is recognised that individual patients in this group may have relief of breathlessness irrespective of blood oxygen saturations at rest. Therefore, where other strategies have failed, it may be appropriate to initiate a trial of oxygen therapy, removing after 3 days in the absence of significant symptomatic benefit.

3 2.5 Urgent delivery should only be selected if clinically indicated. All reasonable efforts should be taken to avoid requesting urgent delivery due to the significant cost that this incurs. It is appreciated that for some patients this will be unavoidable. 3. INITIATING HOME OXYGEN THERAPY FOR OTHER PATIENTS 3.1 This policy only relates to the ordering of oxygen for patients over the age of 18. All patients under the age of 18 should be referred to paediatric specialist secondary care service for consideration of home oxygen therapy. 3.2 Patients experiencing symptoms of cluster headaches should only be receiving home oxygen following a Consultant diagnosis; therefore oxygen therapy should be initiated from secondary care. 3.3 There is no current evidence to support the routine use of short burst oxygen therapy (SBOT) to relieve periods of episodic breathlessness in other conditions. 3.4 All patients should have their saturations tested via pulse oximetry and other causes of breathlessness should be excluded before referral for an oxygen assessment is considered. 3.5 All patients with a diagnosis of COPD should be optimised according to Hull and East Yorkshire COPD Guidelines prior to being considered for Home Oxygen Therapy. 3.6 Where clinically appropriate (other than palliative care patients): patients with a SpO2 92% should be referred to the Home Oxygen Service for assessment and consideration of oxygen therapy patients that demonstrate a desaturation on exertion should also be referred to the Home Oxygen Service for consideration of ambulatory oxygen therapy. 3.7 Patients presenting with SpO2 92% and breathlessness should be considered for referral to the appropriate support service (Community Respiratory Nurse, Heart Failure Nurse, Physiotherapy, Occupational Therapy). 3.8 Following specialist review, it may be indicated to initiate short burst oxygen therapy in a small number of patients with mild to moderate hypoxaemia that continue to have debilitating dyspnoea despite trying all appropriate other interventions, both pharmacological and non-pharmacological. 3.9 For patients where a diagnosis of COPD is confirmed, a referral to Pulmonary Rehabilitation should be considered.

4 4. ORDERING OXYGEN THERAPY 4.1 If the patient does not currently receive home oxygen therapy, a Home Oxygen Consent Form (HOCF) must be completed. The referring clinician does not need to forward the HOCF to the supplier; by signing and faxing the HOOF, the clinician is confirming they have sought consent from the patient to the sharing of information to the following organisations: The supplier Fire and Rescue services Patient s electricity supplier 4.2 Where a patient has oxygen therapy needs, it is anticipated that for palliative patients the HOOF will be completed by the GP. A copy of the HOOF should be faxed to the Home Oxygen Service. Completion of the diagnostic code box is essential prior to faxing. 4.3 For all other cases, the indication for oxygen therapy should be confirmed by either the Home Oxygen Service or the relevant Specialist Secondary Care Clinician. The HOOF will be completed by the relevant specialist clinician. The HOOF will be completed by the relevant specialist clinician either from the Home Oxygen Service or the relevant Specialist Secondary Care Clinician. 4.4 The supplier will continue to supply the oxygen therapy until the supplier receives: 1. a revised HOOF for that patient 2. written notification of termination of oxygen therapy 3. contact from a carer or clinician to notify of the patient s death TE: Following a change in the contract agreement, a new HOOF is not required for change of address or holiday order, providing there is no change to the flow rates/ equipment required. 4.5 On receipt of the HOOF, the supplier will fax to the referrer a written confirmation of the supply arrangements 5. Communication with Practices Upon receipt of any newly initiated HOOF, practices will be contacted immediately by the Home Oxygen Service to confirm the following information: To query if the new HOOF appears to be a duplicate order from existing data held To check clinical code if omitted from the HOOF to identify type of patient To recommend referral to Home Oxygen Service should this be clinically appropriate but not initiated

5 Appendix 1 Palliative Care Oxygen Pathway for use in Primary Care Patient Presents Is patient palliative (ie likely to be in the last weeks/days of life?) Is SaO 2 <92% consider all causes of breathlessness Is SaO 2 <92%? Consider alternative management strategies for SOB. Consider referral to alternative services (e.g. MacMillan, Physiotherapy, NCT). Refer to Home Oxygen Service for Home Oxygen Assessment Consider: contraindications for prescribing oxygen? Contraindications identified contraindications identified Complete HOOF PART A ensuring compulsory fields including diagnosis are entered and HOOF is signed by an appropriate Clinician. Fax HOOF to Air Products and PCT oxygen lead on THE SUPPLIER SHOULD BE TIFIED IMMEDIATELY OF: Patient Change of Address (permanent or temporary for example holiday) Notification can be made by telephone if no change to requirements. New HOOF, to be completed by HOS-AR, required if changes to requirements Termination of Order (written notification of cancellation faxed to with transmission confirmation kept as proof) Patient Death Review treatment and assess patient after 4 weeks. Does patient still require oxygen? Send written notification of order cancellation to Supplier with copy to PCT Consider referral to Specialist Palliative Care Team for assessment. Ensure periodic monitoring to assess continued effectiveness of oxygen therapy.

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