Comparative audit of oxygen use in the prehospital setting in acute COPD exacerbation over 5 years.
BACKGROUND
In 2009 the Wellington Free Ambulance implemented an education programme to reduce high concentration oxygen delivery to patients with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). The aim of this audit was to compare pre-hospital oxygen delivery to patients with AECOPD before and after the programme.


METHODS
An audit of patients who presented to Wellington Regional Hospital by ambulance with an AECOPD in 2005 and then in 2010, after implementation of the education programme. Oxygen therapy was categorised as: HIGH, supplemental high concentration oxygen therapy ≥3 L/min and/or delivery via high concentration mask; NEB, high concentration oxygen only during nebuliser use; or LOW, neither of these.


RESULTS
In 2005 those in the HIGH, NEB and LOW categories were 81 (75.0%), 18 (16.7%) and 9 (8.3%) of 108 identified patients. In 2010 those in the HIGH, NEB and LOW categories were 80 (44.0%), 61 (33.5%) and 41 (22.5%) of 182 identified patients. The proportions of patients in the three oxygen groups were significantly different between 2005 and 2010 (p<0.001).


CONCLUSIONS
The proportion of patients administered supplemental high concentration oxygen therapy markedly decreased between 2005 and 2010 following implementation of the education programme. However, in 2010 more than half of the patients not managed with high concentration oxygen therapy were still exposed to high concentration oxygen through the use of oxygen-driven nebulisers. To reduce exposure to high concentration oxygen in AECOPD the use of air-driven nebulisers or metered dose inhalers with spacers is required.
Medical Research Institute of New Zealand, Wellington, New Zealand Capital & Coast District Health Board, Wellington, New Zealand Victoria University Wellington, Wellington, New Zealand.
Janine
J
Pilcher
Medical Research Institute of New Zealand, Wellington, New Zealand Capital & Coast District Health Board, Wellington, New Zealand.
Laird
L
Cameron
Medical Research Institute of New Zealand, Wellington, New Zealand Capital & Coast District Health Board, Wellington, New Zealand Victoria University Wellington, Wellington, New Zealand.
Irene
I
Braithwaite
Medical Research Institute of New Zealand, Wellington, New Zealand Capital & Coast District Health Board, Wellington, New Zealand.
Darren
D
Bowles
Capital & Coast District Health Board, Wellington, New Zealand University of Otago Wellington, Wellington, New Zealand Wellington Free Ambulance, Wellington, New Zealand.
Andrew
A
Swain
Wellington Free Ambulance, Wellington, New Zealand.
Mark
M
Bailey
Capital & Coast District Health Board, Wellington, New Zealand University of Otago Wellington, Wellington, New Zealand.
Mark
M
Weatherall
Medical Research Institute of New Zealand, Wellington, New Zealand Capital & Coast District Health Board, Wellington, New Zealand Victoria University Wellington, Wellington, New Zealand University of Otago Wellington, Wellington, New Zealand.
Richard
R
Beasley
Medical Research Institute of New Zealand, Wellington, New Zealand Capital & Coast District Health Board, Wellington, New Zealand University of Otago Wellington, Wellington, New Zealand.
Kyle
K
Perrin
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D054869:Clinical Audit; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D004635:Emergency Medicine / Q000193:education; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D010102:Oxygen Inhalation Therapy / Q000009:adverse effects / Q000592:standards / Q000706:statistics & numerical data*; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D012189:Retrospective Studies
COPD