This month I would like to discuss the changes to the Home Oxygen Service (HOS) in the UK. As healthcare professionals ordering home oxygen, we need to be aware that there are changes within the HOS as from the 2nd April 2012. These changes include:
· Development of Home Oxygen Assessment and Review (HOS-AR)
· Healthcare professionals’ responsibility to select equipment
· We have new Home oxygen Order Form (HOOF)
· Updated Home Oxygen Consent Form (HOCF)
One of the oxygen provider companies (Air Liquide) highlighted that the change places a great emphasis on the safety, assessment and clinical decision making when selecting the right equipment, which would meet patients’ lifestyle and needs.
It is important that we understand that we will be responsible for requesting the type of equipment installed, and it’s very important that you understand what equipments are available and how they work.
The vision is that people prescribed oxygen and clinicians alike should be well informed about the nature, scope and capability of the home oxygen service. The service should:
• Have quality at its core - in other words, be accessible, safe, effective and
responsive to patients;
• Be evidence-based, clinically-led and continually strive to improve outcomes for
• Be affordable and represent good value for money
Wherever possible, patients should have a known clinical diagnosis before referral. This should not be a problem in respect of patients referred from secondary care, and for a number of patients referred from primary care (such as those with long-term conditions).
Where patients present in primary care with breathlessness and there is no established diagnosis, wherever possible pulse oximetry should be carried out in order to establish the level of oxygen saturation in the blood.
If the SpO2 level is below 92%, or if is fluctuating around that level, the individual should be referred for a full assessment. If the reading is borderline the patient should be asked to return for repeat oximetry after five weeks.
It is important to establish whether the patient is in a stable condition: in other words, whether the results from oximetry readings are consistent over the fiveweek period. For an unstable patient, if oximetry is below 92% on even one occasion then the patient should be referred for assessment. It is important for the GP to decide that the patient is stable and not having an exacerbation that can induce temporary hypoxaemia.
Where oximetry indicates that referral for full assessment is appropriate and the patient’s condition is stable, the patient should be referred to a home oxygen assessment and review service (HOS-AR) for the appropriate tests. Where the patient’s diagnosis is unclear, then referral should be made to a specialist respiratory physician or nurse.
The provision of HOS has changed at a National level and it is led by the Department of Health. However each region has its own HOS lead and I would suggest you find who the lead is for further advice and guidance.
Speak to you all next month!
Julie Mariaki is a BLF Community Respiratory Specialist Nurse for St George's Healthcare NHS Trust (community division).
She has been practicing in the field of respiratory care for eight and a half years.
Julie did her first degree in Athens Greece and came to the UK in 2000 to continue with her studies. After working in the acute sector for two and half years, she decided to undertake the asthma/COPD module in 2002 as she was interested in respiratory nursing.
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