OXYGEN FOR ADULTS IN ACUTE CARE

Transcription

1 PATIENT GROUP DIRECTION FOR THE ADMINISTRATION OF OXYGEN FOR ADULTS IN ACUTE CARE ALL CLINICAL DIVISIONS ADULT CARE STATEMENT The staff indicated in Staff Group may administer oxygen in the two detailed situations below: Emergency use: Without medical prescription. Target saturations prescribed prior to us. PGD user to titrate percentgae of oxygen to meet perscribed target saturations STAFF GROUP A Nurse, Midwife, Physiotherapist or Occupational Therapist working in the Trust is/are entitled to administer medicines without medical prescription under this patient group direction if they hold the professional qualifications Registered Nurse, Registered Midwife or Chartered Physiotherapist registered with the HPC, and have received appropriate specialist training as detailed below:- Specialist training; Attendance on the new AIMS course or an Oxygen prescribing guidelines module or attended the respiratory physiotherapy oxygen training and competency assessment or received cascade competency training from trained assessors within Tameside Hospital NHS Foundation Trust CLINICAL CONDITION TO BE TREATED Indications in adults: 1. Emergency use: Acutely unwell individual. 2. Hypoxaemia Suspected hypoxaemia Breathlessness with hypoxaemia Post operative patients on PCA or epidural Exclusions in adults: 1. When clinical indications not met 2. Doctors prerogative -must be referred to the responsible medical officer for advice, documentation and provision of treatment Page 1 of 5

2 NAME OF DRUG Oxygen (02) LEGAL STATUS OF DRUG DOSE TO BE GIVEN Prescription Only Medicine (POM). Emergency use: Non Rebreathe Mask 15lpm estimated 85% oxygen Target saturations prescribed by doctor thus dose is variable according to need. Dose varied must be documented by PGD user on TPR chart FREQUENCY OF ADMINISTRATION Emergency use: Continuous until clinical condition improves or an oxygen prescription is written. Continuous until target saturation achieved with patient on room air NUMBER OF DOSES TO BE GIVEN ROUTE OR METHOD OF ADMINISTRATION CONTRA- INDICATIONS TO USE OF DRUG Not applicable Inhaled Contraindications: None Cautions: As stated in the manufacturer s data sheet/summary of product characteristics if adult patient at risk of hypercapnia. See oxygen guidelines Cautions of hyperoxia and supplemental oxygen: Physiological risks Worsened V/Q mismatch Absorption Atelectasis Coronary and cerebral vasoconstriction Reduced cardiac output Damage from oxygen free radicals Increased systemic vascular resistance Clinical risks Worsening of hypercapnic failure Page 2 of 5

3 Delay in recognition of clinical deterioration Worse outcomes in mild to moderate stroke Specific risk of lung fibrosis with previous bleomycin lung damage or with paraquat poisoning or acid aspiration Unknown risk / benefit balance in acute coronary artery disease with normal oxygen saturations DRUG INTERACTIONS MANAGEMENT OF ADVERSE REACTIONS If the patient is receiving any concomitant medication or treatment it is the responsibility of the health professional identified in STAFF GROUP to ensure that treatment with the drug detailed in this direction is appropriate. In case of any doubt further advice must be sought from the appropriate health professional and recorded as having been sought before the drug is given. 1. Stop oxygen therapy monitor saturations continuously. (Do not let saurations drop below 88% without doctors written consent) 2. Immediately inform senior doctor to review for further management. 3. Record respirations, saturations, pulse, blood pressure, temperature, Urine output and central nervous system. Refer to AIM guideline. 4. Record any adverse reaction symptoms, date and time in medical notes. ADVICE TO BE GIVEN TO PATIENT. Oxygen is a medication to help reduce breathlessness when oxygen levels in the body are low. Try to keep the oxygen mask in place at all times, only removing it for short periods for example eating and drinking. Oxygen relieves the breathlessness by increasing oxygen to the red blood cells to oxygenate the body. It involves an oxygen mask being placed over the nose and mouth or a nasal cannulae placed under your nostrils whilst you breath in and out as normally as possible. Try to avoid flat lying or slumped postions as this will worsen your breathlessness. If the breathlessness continues or Respiratory Rate is > 30bpm, despite reaching target saturations, the flow rate on the venturi mask will be increased by 50% to help reduce the sensation of air hunger You may have oxygen if you have an epidural in place or are using a PCA. This is to ensure that the medictaion used in these devises do not adversley affect the oxygen levels in the blood FOLLOW UP Emergency use: ARRANGEMENTS Monitor and chart all observations as per AIMS /PARS Page 3 of 5

4 guidelines and respond promptly to PARs trigger points. Senior Doctor must be informed of emergency use immediatley. Achieve target saturations ASAP via using the mask titration chart Once target saturation achieved monitor all observations including saturations and respiratory rate minimum 4 hourly. Titrate oxygen down, maintaining target saturations until patient Is on room air. At this point the oxygen prescription should be discontinued / crossed off the drug prescription sheet DOCUMENTATION TO BE COMPLETED Emergency use: Retrospective documentation of emergency oxygen therapy as per AIMS / PARS guidence Doctors to prescribe target oxygen saturations on prescription sheet once patient is stable and the PGD user should then adhere to standard use guidance (see below) The target saturation will be prescribed and documented on the oxygen prescription chart,and / or casualty card (A&E Department) with the time and date. The PGD user will review the oxygen therapy during observation monitoring and drug rounds and document (initial and date) any changes or stasis in therapy on the prescription sheet. DIRECTION PREPARED BY Catharine Thomas Consultant Respiatory Physiotherapist DIRECTION APPROVED BY MR. P. DYLAK Director of Nursing A.L.SIVNER Chief Pharmacist REVIEW It is the responsibility of the head of the professional body to whom the direction applies to action the review process. Direction created on 20/03/ 2009 This direction must be reviewed by 20/03/2010. In addition to the above, the patient group direction must be submitted to the Chairperson of the Drug and Therapeutics Committee for approval by that committee. The patient group direction will remain valid until the next available meeting of the Drugs and Page 4 of 5

5 Therapeutics Committee following the review date at which time a decision will be made regarding its future use. APPROVED BY DRUG AND THERAPEUTICS COMMITTEE DR T. BRAMMAH CHAIR All patient group directions should be subject to regular review in line with changes in clinical practice APPROVED BY CLINICAL GOVERNANCE SUB-COMMITTEE ( on behalf of Trust Board) The patient group direction is to be read, agreed to, and signed by all health professional staff it applies to. One copy is given to the health professional to retain within their professional portfolio, and another to his / her manager to be retained by the manager within the ward or department I have read the patient group direction, agree to use it in accordance with the criteria described and have been assessed as competent by an appropriate practitioner in accordance with the assessment pro-forma contained in this document. Name: Review date: I declare that the above named has been assessed as competent to supply or administer medicines in accordance with this patient group direction. I am competent to perform this assessment and I confirm that the above individual is a member of the staff group to which the PGD applies Name: Page 5 of 5

6 This Patient Group Direction (PGD) was approved by the Trust on ( date). Any health care professional working within this PGD must ensure that it is the most recent version, This can be confirmed on the Trust Intranet Page 6 of 5

7 PATIENT GROUP DIRECTION FOR THE ADMINISTRATION OF OXYGEN ASSESSMENT OF COMPETENCE HEALTH CARE PROFESSIONAL ( name) The health care professional is able to : 1 Understand fully the clinical situation(s) in which the PGD may be applied 2 Understand for whom the PGD cannot be used and which patient group(s) must be referred to a doctor 3 Understand the contraindications and exclusions for the medicine (including the potential for interaction with other prescribed medicines) 4 Name the medicine; dosage; method and route of administration; frequency and duration of treatment ; and maximum dose 5 Understand how to recognise and manage any drug related adverse or untoward reactions. 7 Understand how and where to document the administration of the medcine 8 Demonstrate competency in the supply or administration of the medicine and the clinical procedure in which it is used Individual Self- Assessment ( sign when competent) Assessors Confirmation ( sign when competent) Name: Assessors Date Page 7 of 5