title: Implementation of a multicomponent intervention to optimise patient safety through improved oxygen prescription in a rural hospital.
abstract: OBJECTIVE
  To rationalise oxygen procedures in adult medical and surgical inpatients with a view to improving patient safety.
  
  
  METHODS
  Prospective pre- and post-intervention audit.
  
  
  METHODS
  Manning Hospital, a rural referral hospital in Taree NSW.
  
  
  METHODS
  Pre-intervention: 82 patients aged 72.7 ± 14.7 years. Post-intervention: 77 patients aged 73.6 ± 12.4 years.
  
  
  METHODS
  A multicomponent intervention composed of implementation of a local hospital oxygen policy, introduction of a specific oxygen prescription chart and targeted staff education.
  
  
  METHODS
  Satisfactory oxygen prescription, monitoring and titration.
  
  
  RESULTS
  Only 2/82 (2.4%) patients had satisfactory oxygen prescription specifying target saturation, device and initial flow rate before the intervention compared with 26/77 (34%) patients post-intervention (χ(2)  = 56.88, df = 5, P < 0.0001). Percentage of patients with conditions predisposing to hypercapnic respiratory failure who were overtreated with oxygen dropped from 9/19 (47%) to 4/22 (18%) following the study intervention (χ(2)  = 4.011, df = 1, P = 0.04). Oxygen therapy monitoring was satisfactory during the audit period, but oxygen titration was unsatisfactory and did not significantly improve following the intervention.
  
  
  CONCLUSIONS
  A multicomponent intervention can achieve a significantly increased rate of satisfactory oxygen prescriptions specifying target saturation, including in those who are at risk of hypercapnic respiratory failure.
authors.affiliation: Department of General Medicine, John Hunter Hospital, New Lambton, New South Wales, Australia.
authors.forename: Roshan
authors.initials: R
authors.lastname: Gunathilake
authors.forename: Deborah
authors.initials: D
authors.lastname: Lowe
authors.forename: James
authors.initials: J
authors.lastname: Wills
authors.forename: Anne
authors.initials: A
authors.lastname: Knight
authors.forename: Peter
authors.initials: P
authors.lastname: Braude
mesh_terms: D000368:Aged; D005260:Female; D006780:Hospitals, Rural; D006801:Humans; D008297:Male; D009517:New South Wales; D016134:Organizational Policy; D010102:Oxygen Inhalation Therapy / Q000379:methods / Q000592:standards; D061214:Patient Safety; D055656:Prescriptions / Q000592:standards; D058996:Quality Improvement
keywords: multicomponent intervention; oxygen prescription; rural setting; safety and quality; target saturation