New Home Oxygen Contract

Transcription

1

2 New Home Oxygen Contract n There are two Home Oxygen Order Forms (HOOFs): Part A HOOF for non specialist clinicians prior to a formal oxygen assessment Part B HOOF for Home Oxygen Assessment and Review Services (HOS-AR), Paediatric and other Specialist Teams. This is a restricted document n Healthcare professionals are responsible for selecting the correct equipment type and quantity to ensure their patients clinical and lifestyle needs are being met This guide is designed to support Part A Prescribers. The HOOF should be completed and sent to Air Liquide once you are satisfied that the patient is suitable and safe for the provision of home oxygen. 2

3 Part A HOOF What is a Part A HOOF? The Part A HOOF is a Home Oxygen Order Form which will enable the prescriber to order oxygen equipment. This should only be used where a patient cannot wait for a formal oxygen assessment by a Specialist Oxygen Service. How can I access a Part A HOOF? The HOOF Part A can be accessed through the following HCP Portal: What equipment can I order on a Part A HOOF? The Part A HOOF can only be used to order a static concentrator and/ or large static cylinders. It cannot be used to order ambulatory oxygen equipment. 3 How to Complete a Part A HOOF

4 Part A HOOF Who should I send my Part A HOOF to? Through the HCP Portal, Air Liquide will automatically receive your HOOF and a copy will be downloaded onto your computer for your records. Alternatively you can your HOOF to: alhomecare.hcpsupport@nhs.net Your HOOF will be processed between 08:30 17:00 with the exception of emergency orders. How will I know that Air Liquide has accepted my HOOF? You will need to provide a return safe haven or fax number in the HOOF declaration. 13. Declaration* I declare that the information given on this form for NHS treatment is correct and complete. I understand that if I knowingly provide false information, I may be liable to prosecution or civil proceedings. I confirm that I am the registered healthcare professional responsible for the information provided. I also confirm that the patient has read and signed the Home Oxygen Consent Form. Name: DR NIELS MARSHALL Signature: Date: Referred for assessment: Yes No Fax back no. or NHS address for confirmation / corrections: 12. Clinical Contact (if applicable) 12.1 Name: DR NIELS MARSHALL 12.2 Tel no Mobile no Profession: GP 01/10/2016 drnielsmarshall@nhs.net If you provide this, you will receive a HOOF Confirmation within 1 working day (within 1 hour for any next day or urgent HOOFs). If Air Liquide have any queries or require clarification on any aspect of the HOOF, we will contact you directly to discuss. You should therefore ensure that the HOOF contains your clinical contact details. If we cannot contact you this may result in the HOOF not being processed. x 4

5 Part A HOOF How quickly will my patient receive their oxygen? There are 3 delivery options available on the HOOF: n Standard (3 Business Days) The majority of patients will require this option n Next (Calender) Day This option should only be selected by Part B Prescribers where a formal oxygen assessment has been completed or to facilitate a Hospital discharge n Urgent (4 Hours) This option is more costly to the NHS and it should only be used where there is a clinical need for the patient to receive their oxygen within 4 hours You must make it clear when completing your HOOF how quickly your patient requires their oxygen and ensure that somebody is at the delivery address to receive the oxygen equipment and the training. x 10. Delivery Details* 10.1 Standard (3 Business Days) 10.2 Next (Calendar) Day 10.3 Urgent (4 Hours) 5 How to Complete a Part A HOOF

6 Part A HOOF What should I do if my patient requires ambulatory oxygen? Ambulatory oxygen can only be ordered by a specialist clinician via a Part B HOOF. If you think your patient requires ambulatory oxygen you should refer them to your local specialist service for a formal oxygen assessment. Can I access a Part B HOOF? As part of the NHS Contract and in agreement with your local CCG, the Part B HOOF is a restricted document which is only available to specialist clinicians. If you are not a specialist clinician you cannot access the Part B HOOF. What should I do if I need to change the current oxygen prescription for a patient? If a patient is already under the care of a specialist oxygen service or already has access to ambulatory oxygen equipment, then you must liaise with the specialist service to discuss this. 6

7 Completing the Part A HOOF How do I complete a HOOF Part A? Before starting the process you will need the following patient information: n NHS number n Full name and contact details n Delivery address n GP Practice n Litres per minute n Hours per day n Equipment type and quantity n Consumables required (nasal cannulae or mask type) Prior to submitting your HOOF to Air Liquide you will need to obtain patient consent to share their details with the oxygen supplier and other parties, including Fire and Rescue Services and electricity distributors. To do this the patient must sign the Home Oxygen Consent Form (HOCF). By signing the HOOF you are agreeing that the patient has completed and signed the HOCF. You should store the HOCF within the Patient s Record. Do no send a copy with the HOOF. 7 How to Complete a Part A HOOF

8 Completing the Part A HOOF The quickest and simplest way to complete a HOOF Part A is through the HCP Portal. Alternatively the Part A HOOF can be completed and sent via or fax. Key points to remember when completing the HOOF Part A n The HOOF must be completed and signed by a registered healthcare professional n Selecting the correct equipment to meet the needs of the patient is the responsibility of the healthcare professional n Provide as much information as possible to ensure that oxygen can be delivered safely n Hours per day should not exceed 24hrs across all modalities n Litres per minute must not exceed 15 n Where a patient is prescribed a concentrator Air Liquide will automatically provide a back-up cylinder for use in emergencies, e.g. power cut. You should not request a back-up cylinder on the HOOF, unless additional cylinders are required 7. Order* 8. Equipment* For more than 2 hours/day it is advisable to select a static concentrator 9. Consumables* (select one for each equipment type) Litres / Min Hours / Day Type Quantity Nasal Cannulae Mask % and Type Static Concentrator Back up static cylinder(s) will be supplied as appropriate 8.2 Static Cylinder(s) Asingle cylinder will last for approximately 8hrs at 4l/min Clinical Considerations n A concentrator is recommended for those patients who have hypoxaemia requiring more than 2 hours of oxygen per day as it will not run out or require frequent deliveries n There is no evidence to support the use of short burst (intermediate oxygen therapy) to relieve breathlessness of patients with oxygen saturation levels of 92% and above 8

9 Safety Considerations A full risk assessment should be undertaken prior to ordering home oxygen, ideally using a Risk Assessment Tool. Patients should be made aware of the dangers of using home oxygen. Remember, patients must: n NEVER smoke or let anyone else smoke near them whilst using their oxygen equipment n NEVER use or let anyone near them use an E-Cigarette whilst they are using their oxygen equipment n NEVER charge an E-Cigarette or similar device close to them whilst they are using their oxygen equipment or near the equipment itself n NEVER use their oxygen equipment near an open fire or naked flames, such as matches, lighters, gas cookers or candles n NEVER use oxygen near other sources of heat such as toasters, electric or gas heaters or boilers n NEVER use Vaseline or other oil based creams when using oxygen equipment n NEVER use oxygen equipment near to oils or grease n ALWAYS turn off the oxygen equipment when they are not using it Air Liquide will also reiterate these messages as part of the installation and on an ongoing basis, during service and risk assessment. 9 How to Complete a Part A HOOF

10 Example Part A HOOF Home Oxygen Order Form (HOOF) Part A (Before Oxygen Assessment Non-Specialist or Temporary Order) All fields marked with a * are mandatory and the HOOF will be rejected if not completed 1. Patient Details 1.1 NHS Number* 1.7 Permanent address* 1.9 Tel no. 1.2 Title 1.10 Mobile no. 1.3 Surname* 2. Carer Details (if applicable) 1.4 First name* 2.1 Name 1.5 DoB* 2.2 Tel no. 1.6 Gender Male Female 1.8 Postcode* 2.3 Mobile no. 3. Clinical Details 4. Patient s Registered GP Information 3.1 Clinical Code(s) Main Practice name:* CAINE & ARKWRIGHT 3.2 Patient on NIV/CPAP Yes x No 4.2 Practice address: 272, THE ROSE WALK, TOWNVILLE, DORSETSHIRE 3.3 Paediatric Order Yes x No GP CODE Nxxxx 4.3 Postcode* BC42 4DG 4.4 Telephone no Assessment Service (Hospital or Clinical Service) 6. Ward Details (if applicable) 5.1 Hospital or Clinic Name: 6.1 Name: 5.2 Address 6.2 Tel no.: 5.3 Postcode: 5.4 Tel no: 7. Order* 8. Equipment* For more than 2 hours/day it is advisable to select a static concentrator 6.3 Discharge date: / / 9. Consumables* (select one for each equipment type) Litres / Min Hours / Day Type Quantity Nasal Cannulae Mask % and Type 8.1 Static Concentrator Back up static cylinder(s) will be supplied as appropriate 8.2 Static Cylinder(s) A single cylinder will last for approximately 8hrs at 4l/min 10. Delivery Details* 10.1 Standard (3 Business Days) 10.2 Next (Calendar) Day 10.3 Urgent (4 Hours) 11. Additional Patient Information 12. Clinical Contact (if applicable) 12.1 Name: DR NIELS MARSHALL 12.2 Tel no Mobile no Declaration* I declare that the information given on this form for NHS treatment is correct and complete. I understand that if I knowingly provide false information, I may be liable to prosecution or civil proceedings. I confirm that I am the registered healthcare professional responsible for the information provided. I also confirm that the patient has read and signed the Home Oxygen Consent Form. Name: DR NIELS MARSHALL Profession: GP Signature: Date: 01/10/2016 Referred for assessment: x Yes No Fax back no. or NHS address for confirmation / corrections: drnielsmarshall@nhs.net 14. Clinical Code CODE Condition CODE Condition 1 Chronic obstructive pulmonary disease (COPD) 12 Neurodisability 2 Pulmonary vascular disease 13 Obstructive sleep apnoea syndrome 3 Severe chronic asthma 14 Chronic heart failure 4 Interstitial lung disease 15 Paediatric interstitial lung disease 5 Cystic fibrosis 16 Chronic neonatal lung disease 6 Bronchiectasis (not cystic fibrosis) 17 Paediatric cardiac disease 7 Pulmonary malignancy 18 Cluster headache 8 Palliative care 19 Other primary respiratory disorder 9 Non-pulmonary palliative care 20 Other 10 Chest wall disease 21 Not known 11 Neuromuscular disease MRS 22, HOUSE AVENUE JONES TOWNVILLE BETTY DORSETSHIRE JAMES JONES 02/04/ x BC26 7EF x If you have any queries when completing a HOOF contact the Air Liquide Prescriber Support Team on (08:30 17:00 Monday Friday). 10

11 The HCP Portal The Air Liquide HCP Portal is designed to help healthcare professionals: n Select the most suitable equipment from both a clinical and cost effective perspective n Quickly and efficiently complete and send a Part A HOOF 11 How to Complete a Part A HOOF

12 Air Liquide (Homecare) Ltd Alpha House, Wassage Way, Hampton Lovett, Droitwich, WR9 0NX