Hosp Pract (1995). 2023 Jul 26. doi: 10.1080/21548331.2023.2241341. Online ahead of print.
INTRODUCTION: Evidence suggests inappropriate oxygenation may be harmful to patients. To improve oxygen use in our hospital, we initiated a quality improvement project with a goal to reduce the percentage of inappropriate utilization of oxygen by 50% within a year.
METHODS: Nasal cannula (NC) oxygen use data for medicine inpatients was abstracted weekly for chart review. A multidisciplinary team developed a guideline for use. Initiation of NC O2 with a baseline SPO2 > 92% was deemed inappropriate and 3+ consecutive SPO2 > 96% was defined as over-supplementation. Formal interventions included an oxygen use guideline, updated EMR order, unit specific feedback, and magnetic placards. Progress was tracked by control charts.
RESULTS: Baseline data revealed 40% of patients were inappropriately placed on oxygen. 55% of patients had one instance of excessive supplementation. Only half of all improper uses of oxygen had charted medical reasoning and 30% had a corresponding order. Instances of proper oxygen use had orders 48% of the time. Run charts revealed inappropriate initiation was significantly reduced to 27.1% (p < 0.0001) and excessive oxygenation decreased significantly to 34.4% (p < 0.0001) following interventions with no effect on other variables.
CONCLUSIONS: Our interventions significantly decreased improper oxygen initiation and excessive supplementation.