Newcastle Oxygen Service

1
Newcastle Oxygen Service

• Chris Irving MBA BSc

2
Background

• 450 patients on oxygen
• 512 individual accounts
• An annual estimated expenditure in excess of
  500,000
• Significant number of patients on inappropriate
  form of therapy or who no longer require this
  service

3
Team Formed February 2007

• Current investment of 72,286 per annum
• 2 Band 6 Senior nurses to join the COPD supported
  discharge service
• Estimated 1 WTE per 200 patients for inner city
  area
• Specialist training in spirometry, ABG sampling,
  Open Exeter, smoking cessation, excel, COPD, Air
  Liquide Equipment and CBT

4
Aim of the Team

• Provide a quality driven, patient focused, city
  wide oxygen review and assessment service for
  patients currently on and who potentially require
  oxygen therapy across primary and secondary care.

5
Objectives

• Review all patients receiving O2 at home annually
• Provide initial O2 screening for patients
  referred by GPs non respiratory consultants
  either in hospital or in their own home
• Provide 6 week follow up for all new oxygen
  patients

6
Objectives

• To build ongoing relationships with Air Liquide
• To work collaboratively with secondary care
  respiratory service
• To demonstrate significant potential cost savings
  sufficient to justify the retention of the
  service

7
Review Service

• Assessment Process
• Patient selected from database provide by Air
  Liquide (Air Liquide data cleaned)
• GP details checked
• Palliative care and paediatrics excluded
• Hospital base medical/mermaid system notes
  reviewed
• Patients contacted by phone

8
Home assessment

• Oxygen prescription checked against Air Liquide
  data, litres per minute, hrs per day, filter
  check and general safety
• Clinical assessment including SaO2, Spirometry,
  HAD score, medication check and inhaler technique
• Ambulatory assessment within the home
• General social assessment
• Offer smoking cessation, CO monitoring and
  pulmonary rehab if appropriate

9
Home assessment

• Benefits for the patients
• Patients using correct amount and hrs usage of
  oxygen
• Referral to respiratory consultant for assessment
• Referral to district nurse
• Referral to GP/medication review
• Provision of loan equipment/wheelchairs
• Prescription of or change of inhalers
• Referral for social services care
• Referral to welfare rights
• Nutritional supplements
• Cognitive Behavioural Therapy

10
Assessments May Nov 2007

• 425 patients selected for assessment
• 76 patients deceased
• 65 not Newcastle PCT
• 255 patients (May-Nov 2007)
• 91 of these (35.6) had resting oxygen
  saturations above the range in which long term
  oxygen is indicated (SaO2 94)

11
02 Resting Saturations
12
02 Resting Saturations gt94
13
Cost Savings
14
Monthly Expenditure
15
Monthly Expenditure
16
Cost Comparison
17
Cost Savings Realised

• Reduction of oxygen accounts from 512 to 411 May
  Dec 2007
• Monthly oxygen budget reduced from 55,082 to
  44,554 May Dec 2007 annual saving of 126,336
• PCT refunded 63,627 from changes made by Oxygen
  Team July Dec 2007
• Total savings of 189,963

18
Case Study One

• Elderly gentleman prescribed lightweight portable
  oxygen with conserving device (no formal
  assessment)
• Patients SaO2 70 on exertion
• Not triggering conserving device
• Without conserver O2 lasts lt4hrs
• Patient changed to two standard ambulatory
  cylinders with trolley
• Cost saving 13.71 - 4.47 9.42 x 365
  3372.60

19
Case Study One

• Patient received correct modality of oxygen to
  suit his needs
• Patient able to mobilise outdoors without
  excessive desaturation
• Substantial cost saving incurred

20
Case Study Two

• Female prescribed oxygen from GP
• Resting O2 sats 93
• Prescribed LTOT, given one concentrator for the
  living room and one for the bedroom
• 2 x 594.95 1189.90

21
Case Study Two

• Air Liquide technical support contacted
• Joint visit carried out
• Oxygen piped into both rooms from one
  concentrator
• Cost saving of 594.95 per annum

22
ASSESSMENT SERVICE

• As per BTS guidelines 2004 for LTOT and
  Ambulatory oxygen
• Quint (2006) 53 of referrals were prescribed
  following assessment (current UK guidelines)
• Dilworth (1989) 67
• Baudouin (1990) 57
• Walsaw (1988) 71
• Waterhouse (1994) 38

23
Ambulatory Assessments

• April 2006 Dec 2008 54 assessments
• 39 negative
• 15 positive
• Estimated savings at mid point ambulatory 4.38 x
  39 x 365 62349

24
Future Plans

• Carry out hospital LTOT and ambulatory
  assessments at RVI
• Carry out LTOT assessments in the community
• Carry out 6 month audit of patients who have had
  oxygen withdrawn
• Further reduce the amount of inappropriate
  prescribing

25
Summary

• Increased quality of care for patients
• Holistic service
• More evidence based oxygen prescribing
• Reduction of inappropriate patients on oxygen
• Significant cost savings

26
Questions
27
References

• Baudoin, S V et al (1990) Long term domiciliary
  oxygen treatment for chronic respiratory failure
  reviewed, Thorax, 45pp 195-198.
• Dilworth, JP et al (1989) Prescription of oxygen
  concentrators adherence to published guidelines,
  Thorax, 44 pp576-578.
• Quint, J K et al (2006) Impact of new home oxygen
  service on respiratory units doi10.1136/thx.2006.
  065565
• Walsaw, M J et al (1988) Prescription of oxygen
  concentrators for long term oxygen treatment
  reassessment in one district, British Medical
  Journal, Vol 297, pp1030-1032.
• Waterhouse, J C et al (1994) Survey on
  domiciliary oxygen by concentrator in England and
  Wales, European Respiratory Journal, 7
  pp2021-2025.