Transcript Home Oxygen - Dorset CCG

SAFE PRACTICE IN HOME OXYGEN THERAPY
NURSING/CARE/RESIDENTIAL HOMES | HOSPICES | SCHOOLS
31/10/16 l Evan Williams l Respiratory Advisor
Outline
■ GDP
Definition
 Home Oxygen Ordering
 Typical Equipment
 Roles & Responsibilities

■ Examples of Inappropriate Practice
■ Oxygen Safety
Storage
 Use & Administration

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GDP - Good Distribution Practice
Definition & Responsibilities
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GDP and Oxygen
Good Distribution Practice
OXYGEN IS LISTED IN THE
BNF AS A DRUG
WHEN WAS THE LAST TIME
YOU TOOK A MEDICINE?
DID YOU TAKE IT FOR
GRANTED?
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How is Home Oxygen Ordered?
SPECIALIST CLINICAL ASSESSMENT
LTOT – blood gas analysis
AOT – walking test
SBOT – cluster headaches
HOOF and HOCF filled in by Healthcare Professional
HOOF completed online and sent electronically to Air Liquide (Homecare) Ltd
Air Liquide receives HOOF and processes it according to the prescriber’s instructions
Air Liquide arranges delivery of the Home Oxygen equipment with the patient
Patient contacts Air Liquide for refills and reports faults if they occur
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Typical set up for patient requiring LTOT and AOT
AirSep® NewLife® Concentrator
Low Flow (0.5L/min)
Elite (1-5 L/min)
Intensity (2-8L/min)
Back Up Cylinder (10 Litre)
To supply at least 8 hours of oxygen
ONLY to be used in the event of a
mechanical fault and/or power failure
Portable cylinders (2 Litre)
For ambulatory use only
There are several different types of static and portable cylinders
They all look similar to each other, but deliver a range of flow rates
Please ensure cylinders are labelled and used for that named patient only
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So What is Good Distribution Practice?
■ It is a quality system for ensuring that medical products are consistently
stored, transported and distributed under suitable conditions
■ It is designed to ensure that the quality of a medical product is maintained
and that the product remains traceable
■ It is a legal requirement to comply with GDP when storing and handling
medical gases
■ It covers all aspects of storage, transport and distribution from the receipt
and storage of medical products, the premises, the training of staff to the
delivery of the medical product to the customer
■ It requires adherence to detailed written procedures for each process that
could affect the quality of the delivered product
GDP PROTECTS THE SAFETY & WELLBEING OF PATIENTS
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Who is responsible for Good Distribution Practice?
All of us are responsible for GDP
■ Qualified Person (Q.P.)
Ensures the conditions of the licence are met
 Ensures GDP is followed
 Ensures the quality system for the storage and distribution of medicinal
products is implemented and maintained
 Safeguards patients against the potential hazards arising from poor
distribution practices

■ Nursing Homes / Care Homes / Hospices / Schools have a responsibility
to ensure our oxygen is administered correctly to the named patient
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Who is responsible for Good Distribution Practice?
■ Care workers may administer prescribed medication (including controlled
drugs) to another person with their consent, provided this is done in
accordance with the prescriber’s directions (The Medicines Act 1968)
■ Health and Social Care Act 2008 (Regulated Activities) Regulations
2014: Regulation 12 ‘Safe Care & Treatment’
1) “Care and treatment must be provided in a safe way for all service users”
2) “…the things which a registered person must do to comply includes:”
2e) “ensuring that the equipment used by the service provider for providing care or
treatment to a service user is safe for such use and is used in a safe way;”
2g) “the proper and safe management of medicines”
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Who is responsible for Good Distribution Practice?
■ Care Quality Commission (CQC)
the independent regulator of health and adult social care in England
 ensure health and social care services provide people with safe, effective,
compassionate, high-quality care and to also encourage improvements
 monitor, inspect and regulate services to make sure they meet fundamental
standards of quality and safety and publish what they find to help people
choose care
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■ “CQC can prosecute for a breach of this regulation or a breach of part of the
regulation if a failure to meet the regulation results in avoidable harm to a person
using the service or if a person using the service is exposed to significant risk of
harm” (Regulation 12: Safe Care and Treatment, CQC website)
■ In 2013 CQC fined Selby care home £8,000 for failure to meet medication
regulations. CQC Director stated:
 “It is a provider’s legal duty to ensure that it has appropriate arrangements in
place to manage medicines in a safe way” (CQC website)
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Examples of Inappropriate Practice
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Examples of Inappropriate Practice
Giving oxygen that has been ordered for one patient on a HOOF to
somebody else for emergency or temporary use
Patient A has a concentrator with back up (BU) cylinder and 2 x portable cylinders
 Other residents use the BU cylinder for emergencies whilst they wait for an ambulance:

■ Patient A is now without BU and at risk if their concentrator or electricity supply fails

Staff decide to give Patient A’s portable cylinders to Patient B who becomes breathless
when walking to the bathroom and to move around the home:
■ Patient B is a CO2 retainer and becomes apnoeic due to administration of high flow oxygen
■ Patient A has no cylinders to meet their oxygen prescription
Sharing oxygen equipment between residents is not permitted
Care facilities should purchase/rent large cylinder(s) if required for emergency
use only and should be administered under a written clinical protocol
The urgent need for oxygen supply would need to be assessed by medically trained staff
(UK Medicines Information, February 2015)
 NHS home oxygen must be ordered on a HOOF and used for that named patient only
 Specialist assessment is needed for LTOT or AOT

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Examples of Inappropriate Practice
Using oxygen equipment named for someone on a HOOF who has
since passed away or no longer requires it clinically
■ Home oxygen was ordered for that patient only
■ All equipment for that named patient must be removed
Sharing oxygen equipment between residents is not permitted
■ A removal request must be sent to Air Liquide as soon as the oxygen
equipment is no longer required (RIP / clinical reason)
■ Billing to the CCG will stop immediately upon receipt of removal
request and the Technician will contact you to arrange removal
■ Specialist assessment is needed for LTOT or AOT
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Examples of Inappropriate Practice
Altering equipment such as adding extra tubing
■ Following installation of oxygen, patient’s requirements have changed and he/she
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would now like to access the common room
Tubing provided at the time of the risk assessment and installation is now not long
enough to meet the patient’s needs
Somehow, staff acquired additional tubing to extend the length of tubing that the
patient had been given by Air Liquide Technician
This creates a further trip hazard and may lead to patient not receiving the correct
flow rate
Maximum tubing length allowed is 15 metres
Patient needs to access other parts of the home, but you are not permitted to
alter our equipment as you will be tampering with a medical device. Options?
■ Call Air Liquide and ask for Technician visit to review the tubing
■ Call oxygen prescriber to discuss any benefit to having a second concentrator
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Oxygen Safety
Storage
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Oxygen Safety - Storage
Fire Risks
■ Materials burn much faster in oxygen than in air alone
■ NEVER smoke or let anyone smoke near you while they are using
oxygen equipment
■ NEVER use the oxygen equipment near (within 3m) open fires
or naked flames
■ ALWAYS contact Air Liquide (Homecare) Ltd to tell us what oxygen
equipment was involved in the fire
■ NEVER use any oxygen equipment that has been involved in a fire or accident
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Oxygen Safety - Storage
■ ALWAYS follow the advice given to you by your Homecare Technician about the
safest place to store and use your oxygen equipment
■ ALWAYS ensure oxygen equipment is stored in a well ventilated area,
kept clean, dry and away from any sources of heat or fire e.g. convection
heaters, gas or electric fires, gas cookers etc
■ NEVER store oxygen equipment close to paint, oil, grease or any
domestic heating gases
■ NEVER keep combustible materials near oxygen equipment e.g.
newspapers, magazines, and other items that may burn easily
■ ALWAYS store the liquid oxygen unit upright
It is advisable to keep back up cylinders and cylinders not in use in a locked
room with appropriate signage – easily accessible when required – key to be
with staff in charge at every shift
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Oxygen Safety
Usage & Administration
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Oxygen Safety – Usage
Materials will become saturated or enriched with oxygen and may burn very
quickly and fiercely if they catch fire
■ NEVER leave the cannulae or mask on the bed or chair when oxygen
equipment is switched on
■ ALWAYS turn off the oxygen equipment when not in use
■ BE AWARE of tubing as a potential trip hazard
■ NEVER use petroleum-based products (Vaseline) or other oil based creams to
soothe a sore area around nose or mouth when using oxygen equipment
ONLY use water based / soluble creams or products
■ NEVER share cannulae or masks between patients
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Oxygen Safety – Administration
■ ALWAYS ensure you are only using oxygen equipment for the named patient.
It might be advisable to label individual patient’s equipment
■ ALWAYS check the gauge to ensure there is sufficient oxygen
■ ALWAYS check the oxygen is reaching the patient
■ ALWAYS ensure oxygen is given in line with the prescription:
L/min and hours per day
 Too much oxygen can be detrimental. Some people with respiratory conditions are
‘oxygen sensitive’ and have to use low flow rates or in some cases cannot use
oxygen at all
 These patient have a ‘hypoxic drive’ meaning their need to breathe is triggered by
low oxygen levels. Giving too much supplemental oxygen can cause their
respiratory rate to decrease or even stop!!
 The only way of knowing this is by a formal oxygen assessment
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Specialist assessment is needed for LTOT and AOT
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Summary
■ Everyone is responsible for GDP
■ Nursing/Care/Residential homes, Hospices, Schools and Nurseries
have a legal responsibility to comply with The Medicines Act 1968
■ Nursing/Care/Residential homes, Hospices, need to comply with
standards set out by CQC regarding medicines
■ Oxygen is a safe medicine when used in the correct way. Please
remember:
Safe storage / use and to only ever administer to named patients
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End of presentation
Thank you for your attention