Transcript Oxygen prescription PDSAs @ JPUH

Anna Blackburn
Oxygen Lead for the Project
Consultant Physician
James Paget University Hospitals NHS Foundation Trust
Aims of unified drug chart
 Safety be design features
 Keep it simple
 Avoid repetition (do it once)
 Translatable to e-prescribing
 Regional buy-in
Aim of oxygen prescription (BTS)
 Identify target oxygen saturation
 Keep the patient within their target range
 BTS markers of good practice
 Prescribe oxygen (doctor)
 Sign that oxygen has been checked on the drug round
(nurse)
 Achieve oxygen saturation within the target range
NNUH & JPUH
JPUH / Generic model
NNUH Model
√ Safety be design features
× Keep it simple
× Avoid repetition (do it once)
× Translatable to e-prescribing
× Regional buy-in
Oxygen Prescribing / Administration
 Oxygen is a drug
 Oxygen is one of the most common drugs used in
secondary care
 Generalists (and surgeons) must feel able to prescribe
and administer oxygen safely
Trial version 1
Trial 1 feedback


 Did the chart change the way you review oxygen on the drug round?


JPUH: Yes x 6
NNUH: No x 7
 Were your drug rounds longer?


JPUH: Yes x 6 (doing additional obs on round)
NNUH: No 6 Yes x 1
 Was it easy to understand & use?


JPUH: Yes x 6
NNUH: Yes x 3 No x 4
 Do you think it will improve patient outcomes?


JPUH: Yes x 6
NNUH: Yes x 1; No x 4: Not sure x 2


Very simplistic
There should be space to write down the amount of oxygen the patient is on
 Which chart do you prefer & why?

JPUH: Trial x 5; Current x 1


Encourages appropriate oxygen titration
NNUH: Trial x 1; Current x 6


Can visualise trend in sats
Can record changes & recheck
 Suggestions

Hand pulse oximeter for drug round (JPUH)
Trial 1 – Outcomes (Resp wards)
120
Percent
100
100 100
92
80
60
40
62
43
50
30
20
0
38
20
0
O2
O2 signed SpO2 in
SpO2
prescribed
for
target last above
obs round target
BTS quality parameters
SpO2
below
target
JPUH (N= 8)
NNUH (N=10)
Trial version 2
Feedback on PDSA trial charts
 NNUH
 “This is a retrograde step. Please keep the current model.
The proposed change will add to clinical burden and is
not user friendly” AMU Consultant
 “The chart we already use is perfect” Staff nurse
 JPUH
 Split between V1 & 2 but definitely prefer it to current
chart
Trial 2 – Outcomes (Resp wards)
120
Percent
100
100 100
86 88
86
80
60
50
33
40
20
JPUH (N= 7)
17
14
0
0
O2
O2 signed SpO2 in
SpO2
prescribed
for
target last above
obs round target
BTS quality parameters
SpO2
below
target
NNUH (N=12)
Trial version 3
Campaign for plain English!
Trial 3 – Outcomes (mixed wards)
120
Percent
100
100 100
100
97
88
80
60
40
40
35
25
NNUH (N=20)
20
0
JPUH (N= 8)
0
O2
O2 signed SpO2 in
SpO2
prescribed
for
target last above
obs round target
BTS quality parameters
0
SpO2
below
target
Compromise…
Plain English
Shift away from BTS
universal codes for fixed
percentage oxygen
Feedback so far
 Via Survey Monkey
 “No initial flow rate/%age”
 “Very complex”
 Shop-floor feedback
 Easy to understand
 Time-consuming
 Repetition
worse
25%
39%
35%
About the
same
Better
Unified drug chart – next phase
 E-learning package with App
 Transferrable across the region
 Initial training
 Refresher
 Targeted training