Transcript Steering Group 2

Kent Surrey Sussex
Academic Health Science
Respiratory Network
Oxygen Titration
Joint Project
Andy Collen
Clinical Development Manager, Advanced Paramedic (Urgent & Emergency Care)
Dr Daryl Freeman
Clinical Director, EoE Respiratory Strategic Clinical Network
Oxygen is the most commonly used
drug in emergency medicine
• 34% of emergency ambulance
patients receive oxygen
(Hale KE, Gavin C, O’Driscoll 2008)
• Oxygen is used in
approximately 221,000
ambulance incidents in Kent
Surrey Sussex each year
Oxygen…
• Too much oxygen may cause 2,000-4,000
avoidable deaths per year in COPD flare ups
(National COPD Audit 2003)
• Administration of high flow oxygen to COPD
patients has been associated with increases in
mortality, length of hospital stay, requirement for
ventilation and admission to high dependency
units (Austin 2010)
• In 2009, 281 serious incidents involving poor
oxygen management, resulting in 9 deaths (NPSA
2009)
Solution
Minimising the risk of oxygen
toxicity, by working to BTS
‘target saturation’ guidelines (2008)
and using controlled oxygen
devices: 28% Venturi masks.
Who is involved?
SECAmb
Clinical
Development Team
Kent Surrey Sussex
AHSN
Respiratory Network
South East Coast Ambulance Service
(SECAmb)
650,000 responses to 999 calls
38,000 of those “breathing problems”
71% (26,600) of “breathing problems” taken to
hospital
20% higher than overall conveyance rate
The
6 minute
Oxygen
Cycle
Implementation
• All SECAmb staff members given laminate
on 6 mins cycle Sep-Dec 2012
• Clinical briefing provided through internal
Bulletin and Clinical Instruction alerts
• Local training delivered by SECAmb PPs
and Respiratory Network team
• Annual updates established for all 240
Paramedic Practitioners
• Venturi masks on all SECAmb Ambulances
and Response Cars
Outcomes 1
• Venturi mask standard equipment on all SECAmb
vehicles
• All 240 Paramedic Practitioners are trained and
using the 6 minute cycle
• All 2000 patient facing staff and clinicians have been
made aware of the 6 minute cycle and the Venturi
masks
• Sustainable training established
Outcomes 2
• NIV decreased by 18% in Surrey
between 2012-2013
• Conveyance rate has fallen by 14%
to 65% over the last 3 years
• 5,300 less patients taken to
hospital per annum
Aug 2012 to July 2013
Aug 2013 to July 2014
Var
Sussex
272
238
-12.50%
Surrey
178
145
-18.50%
Kent
497
495
-0.40%
South East Coast Ambulance Service
Reduction in conveyance rate for 999 calls for Breathing Problems
Next Steps
• Audit acidosis on arrival
at A&Es
• 6 Minute Cycle Roll out
programme to all A&Es
across Kent Surrey
Sussex in 2014-15