| Peer-Reviewed

Effect of Educational Intervention on Oxygen Therapy Knowledge and Prescription Practices in an Inpatient Community Hospital: A Quality Improvement Initiative

Received: 23 March 2023    Accepted: 2 May 2023    Published: 6 July 2023
Views:       Downloads:
Abstract

Administering oxygen therapy is an essential part of managing and preventing hypoxemia in both acute and chronic conditions. It is important to note that administering excessive oxygen can also be harmful, particularly in patients with certain respiratory conditions. Therefore, oxygen therapy should always be prescribed and monitored by a healthcare professional. The aim of this quality improvement initiative is to determine the outcome of Education on Knowledge and practice of Oxygen therapy after 8 weeks of intervention. This cross-sectional study was carried out at the Metropolitan hospital center, New York, across the medical wards and intensive care unit (ICU) over a period of 12 weeks. A self-administered structured questionnaire was used to assess knowledge and practice related to oxygen therapy among resident doctors and nurses. Data from electronic prescribing record of all patients who received oxygen therapy over a period of 2 weeks was collected. After 8 weeks of education, questionnaires were distributed again to assess knowledge and practice of oxygen prescription. Data was also collected again from electronic prescribing record of all patients who required supplemental oxygen over a period of 2 weeks. Thirty-two resident doctors participated in this study pre and post educational intervention, while 9 nursing staff participated in the pre intervention phase. Knowledge of respiratory physiology was good (>80%) among resident doctors and nurses. On the average, knowledge of indications for oxygen supplementation was poor (55.5%) pre intervention and moderate (71.1%) post intervention. There was a statistically significant improvement (p value <0.0001) on the erroneous concept of oxygen as a treatment of breathlessness without hypoxia from preintervention (21.9%) to post intervention (75.0%). On the average, knowledge of the conditions in which oxygen saturation of >92% should be avoided was poor among resident doctors (57.3%) and nurses (40.8%) with some improvement post intervention (61%). Objectively, 56.5% of charts had documented oxygen prescription with significant improvement in documentation post intervention to 100% (p 0.0002). Documentation of target saturation in patients chart improved from 21.7% pre intervention to 48.0% post intervention although not statistically significant (0.059). About two-thirds of study participants (63.4%) have not received any training on oxygen supplementation in acute care setting within the past year. We concluded that knowledge of oxygen therapy and practice of oxygen therapy prescription and administration in our healthcare setting is suboptimal. Education improved prescription of supplemental oxygen in patients charts along with inclusion of target saturation.

Published in International Journal of Biomedical Engineering and Clinical Science (Volume 9, Issue 3)
DOI 10.11648/j.ijbecs.20230903.11
Page(s) 30-37
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Oxygen Therapy, Oxygen Prescription, Hypoxemia, Respiratory Failure

References
[1] Stern K, Rao S, Cheng T, Dong H, Fellows I. BEYOND THE BLUE: What Fellows Are Reading in Other Journals Another Look into Oxygen Supplementation in the Acute Care Setting. Am J Respir Crit Care Med. 2020; 201: 478-480. doi: 10.1164/rccm.201905-1029RR.
[2] O’driscoll BR. British Thoracic Society Guideline for oxygen use in adults in healthcare and emergency settings. Open Resp Res. 2017; 4: 170. doi: 10.1136/bmjresp-2016-000170.
[3] Chu DK, Kim LHY, Young PJ, et al. Mortality and morbidity in acutely ill adults treated with liberal versus conservative oxygen therapy (IOTA): a systematic review and meta-analysis. The Lancet. 2018; 391 (10131): 1693-1705. doi: 10.1016/S0140-6736(18)30479-3.
[4] Cousins JL, Wark PAB, McDonald VM. Acute oxygen therapy: a review of prescribing and delivery practices. Int J Chron Obstruct Pulmon Dis. 2016; 11 (1): 1067. doi: 10.2147/COPD.S103607.
[5] Jeffrey AA, Ray S, Douglas NJ. Accuracy of inpatient oxygen administration. Thorax. 1989; 44 (12): 1036-1037. doi: 10.1136/THX.44.12.1036.
[6] Smith GB, Poplett N. Knowledge of aspects of acute care in trainee doctors. Postgrad Med J. 2002; 78 (920): 335-338. doi: 10.1136/PMJ.78.920.335.
[7] Stoneham MD, Saville GM, Wilson IH. Knowledge about pulse oximetry among medical and nursing staff. Lancet. 1994; 344 (8933): 1339-1342. doi: 10.1016/S0140-6736(94)90697-1.
[8] Adverse effects of supplemental oxygen - UpToDate. Accessed June 10, 2022. https://www.uptodate.com/contents/adverse-effects-of-supplemental-oxygen?search=supplemental%20oxygen&source=search_result&selectedTitle=4~150&usage_type=default&display_rank=3
[9] Büsing CM, Kreinsen U, Bühler F, Bleyl U. Light and electron microscopic examinations of experimentally produced heart muscle necroses following normobaric hyperoxia. Virchows Arch A Pathol Anat Histol. 1975; 366 (2): 137-147. doi: 10.1007/BF00433587.
[10] Moradkhan R, Sinoway LI. Revisiting the role of oxygen therapy in cardiac patients. J Am Coll Cardiol. 2010; 56 (13): 1013-1016. doi: 10.1016/J.JACC.2010.04.052.
[11] Girardis M, Alhazzani W, Rasmussen BS. What’s new in oxygen therapy? Intensive Care Med. 2019; 45 (7): 1009-1011. doi: 10.1007/S00134-019-05619-9/TABLES/1.
[12] Hofmann R, James SK, Jernberg T, et al. Oxygen Therapy in Suspected Acute Myocardial Infarction. N Engl J Med. 2017; 377 (13): 1240-1249. doi: 10.1056/NEJMOA1706222.
[13] Siemieniuk RAC, Chu DK, Kim LHY, et al. Oxygen therapy for acutely ill medical patients: a clinical practice guideline. BMJ. 2018; 363. doi: 10.1136/BMJ.K4169.
[14] Abdo WF, Heunks LMA. Oxygen-induced hypercapnia in COPD: myths and facts. Crit Care. 2012; 16 (5): 1-4. doi: 10.1186/CC11475/FIGURES/2.
[15] Austin MA, Wills KE, Blizzard L, et al. Effect of high flow oxygen on mortality in chronic obstructive pulmonary disease patients in prehospital setting: randomised controlled trial. BMJ. 2010; 341 (7779): 927. doi: 10.1136/BMJ.C5462.
[16] Davis DP, Meade W, Sise MJ, et al. Both hypoxemia and extreme hyperoxemia may be detrimental in patients with severe traumatic brain injury. J Neurotrauma. 2009; 26 (12): 2217-2223. doi: 10.1089/NEU.2009.0940.
[17] Roffe C, Nevatte T, Sim J, et al. Effect of Routine Low-Dose Oxygen Supplementation on Death and Disability in Adults With Acute Stroke: The Stroke Oxygen Study Randomized Clinical Trial. JAMA. 2017; 318 (12): 1125-1135. doi: 10.1001/JAMA.2017.11463.
[18] Stolmeijer R, Bouma HR, Zijlstra JG, et al. A Systematic Review of the Effects of Hyperoxia in Acutely Ill Patients: Should We Aim for Less? Biomed Res Int. 2018; 7841295 doi: 10.1155/2018/7841295.
[19] An audit of oxygen therapy on the medical ward in 2 different hospitals in Central Saudi Arabia - PubMed. Accessed February 23, 2023. https://pubmed.ncbi.nlm.nih.gov/12070555/
[20] Pala Cifci S, Urcan Tapan Y, Turemis Erkul B, et al. The Impact of Hyperoxia on Outcome of Patients Treated with Noninvasive Respiratory Support. Can Respir J. 2020; 3953280. doi: 10.1155/2020/3953280.
[21] Leitch P, Hudson AL, Griggs JE, et al. Incidence of hyperoxia in trauma patients receiving pre-hospital emergency anaesthesia: results of a 5-year retrospective analysis. Scand J Trauma Resusc Emerg Med. 2021; 29 (1): 134. doi: 10.1186/S13049-021-00951-W.
[22] Bleomycin-induced lung injury - UpToDate. Accessed June 10, 2022. https://www.uptodate.com/contents/bleomycin-induced-lung injury?search=bleomycin%20induced%20lung%20injury&sectionRank=1&usage_type=default&anchor=H23&source=machineLearning&selectedTitle=1~150&display_rank=1#H3448649854
[23] Oxygenation and Ventilation for Adults | COVID-19 Treatment Guidelines. Accessed June 10, 2022. https://www.covid19treatmentguidelines.nih.gov/management/critical-care-for-adults/oxygenation-and-ventilation-for-adults/
[24] Rochwerg B, Brochard L, Elliott MW, et al. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. European Respiratory Journal. 2017; 50 (2): 1602426. doi: 10.1183/13993003.02426-2016.
[25] Baudouin S, Turner L, Blumenthal S, et al. Non-invasive ventilation in acute respiratory failure. Thorax. 2002; 57 (3): 192-211. doi: 10.1136/THORAX.57.3.192.
[26] Reazaul Karim HM, Burns KEA, Ciobanu LD, et al. Noninvasive ventilation: Education and training. A narrative analysis and an international consensus document. Adv Respir Med. 2019; 87 (1): 36-45. doi: 10.5603/ARM.A2019.0006.
[27] Prescribing oxygen therapy. An audit of oxygen prescribing practices on medical wards at North Shore Hospital, Auckland, New Zealand - PubMed. Accessed February 23, 2023. https://pubmed.ncbi.nlm.nih.gov/16868577/
[28] Al-Otaibi HM. Current practice of prescription and administration of oxygen therapy: An observational study at a single teaching hospital. J Taibah Univ Med Sci. 2019; 14 (4): 357-362. doi: 10.1016/J.JTUMED.2019.05.004.
[29] Singh P, New M, Mon A, Hay C. A quality improvement project on improving the compliance of ‘oxygen prescription with target saturations’ in a district general hospital. Future Healthc J. 2020; 7 (Suppl 1): s69. doi: 10.7861/FHJ.7.1.S69.
[30] Aloushan AF, Almoaiqel FA, Alghamdi RN, et al. Assessment of knowledge, attitude and practice regarding oxygen therapy at emergency departments in Riyadh in 2017: A cross-sectional study. World J Emerg Med. 2019; 10 (2): 88. doi: 10.5847/WJEM.J.1920-8642.2019.02.004.
[31] Rudge J, Odedra S, Harrison D. A new oxygen prescription produces real improvements in therapeutic oxygen use. BMJ Qual Improv Rep. 2014; 3 (1): u204031.w1815. doi: 10.1136/BMJQUALITY.U204031.W1815.
[32] Shrank WH, Rogstad TL, Parekh N. Waste in the US Health Care System: Estimated Costs and Potential for Savings. JAMA. 2019; 322 (15): 1501-1509. doi: 10.1001/JAMA.2019.13978.
Cite This Article
  • APA Style

    Adebola Oluwabusayo Adetiloye, Farhana Alladin, Abida Naz, Kuldeep Ghosh, Olurotimi Badero, et al. (2023). Effect of Educational Intervention on Oxygen Therapy Knowledge and Prescription Practices in an Inpatient Community Hospital: A Quality Improvement Initiative. International Journal of Biomedical Engineering and Clinical Science, 9(3), 30-37. https://doi.org/10.11648/j.ijbecs.20230903.11

    Copy | Download

    ACS Style

    Adebola Oluwabusayo Adetiloye; Farhana Alladin; Abida Naz; Kuldeep Ghosh; Olurotimi Badero, et al. Effect of Educational Intervention on Oxygen Therapy Knowledge and Prescription Practices in an Inpatient Community Hospital: A Quality Improvement Initiative. Int. J. Biomed. Eng. Clin. Sci. 2023, 9(3), 30-37. doi: 10.11648/j.ijbecs.20230903.11

    Copy | Download

    AMA Style

    Adebola Oluwabusayo Adetiloye, Farhana Alladin, Abida Naz, Kuldeep Ghosh, Olurotimi Badero, et al. Effect of Educational Intervention on Oxygen Therapy Knowledge and Prescription Practices in an Inpatient Community Hospital: A Quality Improvement Initiative. Int J Biomed Eng Clin Sci. 2023;9(3):30-37. doi: 10.11648/j.ijbecs.20230903.11

    Copy | Download

  • @article{10.11648/j.ijbecs.20230903.11,
      author = {Adebola Oluwabusayo Adetiloye and Farhana Alladin and Abida Naz and Kuldeep Ghosh and Olurotimi Badero and Oladapo Adewuya and Armeen Poor},
      title = {Effect of Educational Intervention on Oxygen Therapy Knowledge and Prescription Practices in an Inpatient Community Hospital: A Quality Improvement Initiative},
      journal = {International Journal of Biomedical Engineering and Clinical Science},
      volume = {9},
      number = {3},
      pages = {30-37},
      doi = {10.11648/j.ijbecs.20230903.11},
      url = {https://doi.org/10.11648/j.ijbecs.20230903.11},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijbecs.20230903.11},
      abstract = {Administering oxygen therapy is an essential part of managing and preventing hypoxemia in both acute and chronic conditions. It is important to note that administering excessive oxygen can also be harmful, particularly in patients with certain respiratory conditions. Therefore, oxygen therapy should always be prescribed and monitored by a healthcare professional. The aim of this quality improvement initiative is to determine the outcome of Education on Knowledge and practice of Oxygen therapy after 8 weeks of intervention. This cross-sectional study was carried out at the Metropolitan hospital center, New York, across the medical wards and intensive care unit (ICU) over a period of 12 weeks. A self-administered structured questionnaire was used to assess knowledge and practice related to oxygen therapy among resident doctors and nurses. Data from electronic prescribing record of all patients who received oxygen therapy over a period of 2 weeks was collected. After 8 weeks of education, questionnaires were distributed again to assess knowledge and practice of oxygen prescription. Data was also collected again from electronic prescribing record of all patients who required supplemental oxygen over a period of 2 weeks. Thirty-two resident doctors participated in this study pre and post educational intervention, while 9 nursing staff participated in the pre intervention phase. Knowledge of respiratory physiology was good (>80%) among resident doctors and nurses. On the average, knowledge of indications for oxygen supplementation was poor (55.5%) pre intervention and moderate (71.1%) post intervention. There was a statistically significant improvement (p value 92% should be avoided was poor among resident doctors (57.3%) and nurses (40.8%) with some improvement post intervention (61%). Objectively, 56.5% of charts had documented oxygen prescription with significant improvement in documentation post intervention to 100% (p 0.0002). Documentation of target saturation in patients chart improved from 21.7% pre intervention to 48.0% post intervention although not statistically significant (0.059). About two-thirds of study participants (63.4%) have not received any training on oxygen supplementation in acute care setting within the past year. We concluded that knowledge of oxygen therapy and practice of oxygen therapy prescription and administration in our healthcare setting is suboptimal. Education improved prescription of supplemental oxygen in patients charts along with inclusion of target saturation.},
     year = {2023}
    }
    

    Copy | Download

  • TY  - JOUR
    T1  - Effect of Educational Intervention on Oxygen Therapy Knowledge and Prescription Practices in an Inpatient Community Hospital: A Quality Improvement Initiative
    AU  - Adebola Oluwabusayo Adetiloye
    AU  - Farhana Alladin
    AU  - Abida Naz
    AU  - Kuldeep Ghosh
    AU  - Olurotimi Badero
    AU  - Oladapo Adewuya
    AU  - Armeen Poor
    Y1  - 2023/07/06
    PY  - 2023
    N1  - https://doi.org/10.11648/j.ijbecs.20230903.11
    DO  - 10.11648/j.ijbecs.20230903.11
    T2  - International Journal of Biomedical Engineering and Clinical Science
    JF  - International Journal of Biomedical Engineering and Clinical Science
    JO  - International Journal of Biomedical Engineering and Clinical Science
    SP  - 30
    EP  - 37
    PB  - Science Publishing Group
    SN  - 2472-1301
    UR  - https://doi.org/10.11648/j.ijbecs.20230903.11
    AB  - Administering oxygen therapy is an essential part of managing and preventing hypoxemia in both acute and chronic conditions. It is important to note that administering excessive oxygen can also be harmful, particularly in patients with certain respiratory conditions. Therefore, oxygen therapy should always be prescribed and monitored by a healthcare professional. The aim of this quality improvement initiative is to determine the outcome of Education on Knowledge and practice of Oxygen therapy after 8 weeks of intervention. This cross-sectional study was carried out at the Metropolitan hospital center, New York, across the medical wards and intensive care unit (ICU) over a period of 12 weeks. A self-administered structured questionnaire was used to assess knowledge and practice related to oxygen therapy among resident doctors and nurses. Data from electronic prescribing record of all patients who received oxygen therapy over a period of 2 weeks was collected. After 8 weeks of education, questionnaires were distributed again to assess knowledge and practice of oxygen prescription. Data was also collected again from electronic prescribing record of all patients who required supplemental oxygen over a period of 2 weeks. Thirty-two resident doctors participated in this study pre and post educational intervention, while 9 nursing staff participated in the pre intervention phase. Knowledge of respiratory physiology was good (>80%) among resident doctors and nurses. On the average, knowledge of indications for oxygen supplementation was poor (55.5%) pre intervention and moderate (71.1%) post intervention. There was a statistically significant improvement (p value 92% should be avoided was poor among resident doctors (57.3%) and nurses (40.8%) with some improvement post intervention (61%). Objectively, 56.5% of charts had documented oxygen prescription with significant improvement in documentation post intervention to 100% (p 0.0002). Documentation of target saturation in patients chart improved from 21.7% pre intervention to 48.0% post intervention although not statistically significant (0.059). About two-thirds of study participants (63.4%) have not received any training on oxygen supplementation in acute care setting within the past year. We concluded that knowledge of oxygen therapy and practice of oxygen therapy prescription and administration in our healthcare setting is suboptimal. Education improved prescription of supplemental oxygen in patients charts along with inclusion of target saturation.
    VL  - 9
    IS  - 3
    ER  - 

    Copy | Download

Author Information
  • Department of Internal Medicine, New York Medical College, Metropolitan Hospital Center, NYC, USA

  • Department of Internal Medicine, New York Medical College, Metropolitan Hospital Center, NYC, USA

  • Department of Internal Medicine, New York Medical College, Metropolitan Hospital Center, NYC, USA

  • Department of Internal Medicine, New York Medical College, Metropolitan Hospital Center, NYC, USA

  • Division of Cardio-Nephrology, Cardiac Renal & Vascular Associates, Jackson, USA

  • Cardiology Unit, R-Jolad Multi Specialist Hospital, Lagos, Nigeria

  • Department of Pulmonary and Critical Care, New York Medical College, Metropolitan Hospital Center, NYC, USA

  • Sections