New national quality standards published by BTS in September 2017 suggest that all patients who are being considered for long-term oxygen treatment (LTOT) at home should have a thorough risk assessment delivered by trained staff, according to new national standards.
The assessment should include a review of the risk of fire, trips and falls from using oxygen within the home. As part of the process, the smoking status of patients and other household members should be recorded – with safety advice and smoking cessation support supplied as appropriate.
The British Thoracic Society (BTS) is encouraging widespread use of its new set of Quality Standards for Home Oxygen Use in Adults by NHS commissioners, healthcare practitioners and patients to ensure the best possible clinical care.
The Standards also advise that all patients receive:
- a blood gas ‘check-up’ three months after the initiation of therapy, to assess the effectiveness, and future need, of LTOT at home;
- regular ongoing checks by a home oxygen assessment service, at least on an annual basis;
- education and information supplied by a specialist team.
The BTS Quality Standards for Home Oxygen Use in Adults, taken from the BTS Guideline on Home Oxygen Use in Adults (2015) offer ten quality statements summarising the latest, evidence-based practice available. They are endorsed by the Association for Respiratory Technology and Physiology (ARTP), the Association of Respiratory Nurse Specialists (ARNS), the Association for Chartered Physiotherapists in Respiratory Care (ACPRC), the Association of Palliative Medicine (APM) and the Primary Care Respiratory Society UK (PCRS-UK).
Home oxygen therapy involves breathing in air that contains more oxygen than normal from a cylinder or machine at home. It is typically prescribed for patients with heart or lung conditions who continue to have low blood oxygen levels after all other medical treatments have been given.
Latest figures show that around 85,000 people in England have oxygen at home.
Dr Jay Suntharalingam, Co-chair of the BTS Home Oxygen Quality Standard Development Group, commented:
“We’re delighted that the BTS quality standards for home oxygen use in adults are now available so that healthcare professionals can make decisions based on latest available evidence and best practice. It also gives greater clarity for people with respiratory disease, and their families and carers, on what services they should expect.
“Home oxygen can be a highly effective treatment for common lung conditions, including chronic obstructive pulmonary disease (COPD), when blood oxygen levels are low. This allows those affected to enjoy a better quality of life and can potentially improve life expectancy.
“However, as with all specialist treatments, it is vital that home oxygen is administered and reviewed effectively to ensure the safety and best health outcome for patients. The new quality standards provide an outstanding framework for achieving this.”
The BTS Quality Standards for Home Oxygen Use in Adults are as follows. The full text is available here.
- All patients should have home oxygen assessment, carried out by a home oxygen assessment service that includes appropriately trained staff and appropriate equipment.
- All patients being assessed for home oxygen should undergo a risk assessment that includes assessment of individual and household member smoking status, and other household risks of fire, trips and falls.
- All patients initiated on home oxygen should have appropriate education and written information provided by a specialist home oxygen assessment team.
- Patients with advanced stable cardiorespiratory disease who have resting saturations on air that meet the qualifying criteria - should be referred for an LTOT assessment.
- All patients being considered for LTOT should undergo serial blood gas assessments, by the home oxygen assessment service, when stable to confirm both the need for and tolerability of LTOT.
- Review, reassessment and withdrawal: all patients started on LTOT should be followed up with blood gas assessment within three months of initiation of therapy; this includes those patients who are discharged home from hospital on LTOT for the first time. All patients who continue on LTOT should be monitored at least on an annual basis by a home oxygen assessment service. All patients who are identified as no longer requiring any form of home oxygen should have this withdrawn.
- Short burst oxygen therapy (SBOT) should only be offered in the context of cluster headache. SBOT should not be ordered for patients with chronic cardiorespiratory disease.
- Nocturnal oxygen therapy (NOT): Patients with optimally treated cardiac failure, who are not eligible for LTOT, should only be offered NOT if there is evidence of sleep disordered breathing causing daytime symptoms. Patients with chronic hypercapnic respiratory failure with night-time hypoxemia (an abnormally low concentration of oxygen in the blood) who are not eligible or LTOT, should only be offered NOT in conjunction with non-invasive ventilation (NIV).
- Ambulatory oxygen therapy (AOT) – i.e. use of portable oxygen – including outside the home: Patients not eligible for LTOT should only have AOT ordered to facilitate pulmonary rehabilitation or to improve mobility after appropriate formal assessment that includes an exercise test. Patients on LTOT, who are mobile outdoors, should only be offered AOT if this allows them to achieve 15 hours/day compliance with LTOT and/ or improve capacity to undertake outdoor activities.
- Palliative oxygen therapy (POT) can be considered as a trial for patients with hypoxaemia (saturations <92% on air) with refractory dyspnoea due to life-limiting disease that has not responded to opioids and non-pharmacological therapy, for example, fan therapy.
BTS has been at the forefront of producing guidelines for best clinical practice in respiratory medicine since the Society was established over 25 years ago. BTS guidelines are NICE accredited. Quality standards, based on guidelines, are a key part of a range of materials BTS produces to help implement guideline recommendations.
Source of numbers of people in England who have oxygen at home:
For more information, a copy of the quality standard or to arrange an interview, please contact the BTS communications team.
Ed Gyde/ Rosie Strachan
07809 574801/ 020 7831 8778
Note to Editors:
The British Thoracic Society is the UK’s professional body of respiratory specialists. The Society seeks to improve standards of care for people who have respiratory diseases and to support and develop those who provide that care. A registered charity, it has over 3,400 members including doctors, nurses, respiratory physiotherapists, scientists and other professionals with a respiratory interest. For more information, go to www.brit-thoracic.org.uk