Breath Away The Warrington Oxygen Service

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Breath AwayThe Warrington Oxygen Service

• By Carol White

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Background

• 193,700 population area expanding by 2 pr year
• Estimated 105 pt on concentrators, 350 using
  cylinders 455
• Traditionally patients requiring oxygen were seen
  on an ad hoc basis
• Service level agreement - full time Band 7wte
  respiratory specialist nurse
• Expected to see 150 new pt and gt100 cylinder
  patient patient safety was prioritized first
  then cost savings

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• I should have gone to Spec Savers

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Set-up

• Met with the respiratory consultants
• Data was analyzed how any patients were known
  already, urgently waiting, find the unknown on
  LTOT and on cylinders
• Approached CHA for an up-to-date list via Alex
  Chicken
• Organized the clinics how and were and what
  equipment needed to be ordered
• Created the documents needed assessment,
  review, GP letters, adjusted referral pathways
• Sent out flyers to promote the service

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Clinics

• 2 full day clinics in hospital another
  concentrator was purchased to ensure patients
  were assessed on the right equipment
• 2 full days for domiciliary visits for assessment
  and follow up of patients unable to attend
  clinics
• 1 day for administration / teaching / training /
  service development

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Who do I see?

• The service looks to assess any patient with
  hypoxia on maximum therapy but primarily patients
  with respiratory conditions including
• COPD
• Interstitial lung disease
• Lung Cancer and palliative care
• End stage heart failure
• Neurological disorders affecting breathing

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What happened as things progressed

• I prioritized patients based on need those who
  did not have oxygen were at risk
• All patients were classed as new to the service
  so the assessments were equitable as much of the
  information was out of date
• Data was analyzed and showed many errors
• Documentation was adjusted
• An increase in the need for ambulatory
  assessments was identified

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What Else?

• Ensuring the patients get a timely assessment and
  review has helped to prevent hospital admissions
• It ensures medication reviews are undertaken
  identifying dexterity, concordance and
  polypharmacy issues
• Stronger links were forged with other agencies to
  help with the management of complex patient
  management
• Patients are referred on eg pulmonary rehab

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Patient benefit

• Timely intervention has helped with symptom
  relief such as
• Dyspnoea
• Sleeping
• Weight control
• Lethargy
• Mental alertness and concentration

• Treating the patient holistically with
  understanding can transform a dependant patient
  into a confident independent person feeling more
  secure in the knowledge the oxygen is there

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The down side

• Once the oxygen is in it can be difficult to
  remove psychological dependence
• There is a lot of paperwork which is very time
  consuming
• It is growing all the time and demand is
  outgrowing the capacity this needs to be built in
  to future plans

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The future

• Try to get more help!!
• Develop the service at Halton
• Continue with research and audit with patient
  feedback to see what the patient wants
• Independently prescribe to stop the delays in
  initiating therapy and treat COPD exacerbation to
  prevent admissions
• Present more posters papers on the service to
  share practice

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• Onwards and Upwards