Zibrak J D, Sommerville J, O'Donnell C
Respir Care. 1987 Oct;32(10):859-64.
We prospectively investigated strategies for assuring that oxygen was provided to patients hospitalized in our institution, according to standard indications (Blue Cross/Blue Shield Medical Necessity Guidelines).
After a baseline observation period (Phase I) during which no specific interventions were made, therapists were informed that appropriate oxygen utilization was an administrative goal and a department priority, and intensive instruction and case review were provided by the Technical and Medical Directors (Phase II). In Phase III, therapists were encouraged to continue to assure that guidelines were met, but instruction, discussion, and review ceased, and the Technical Director assumed responsibility for all oxygen therapy decisions. Finally, all concerted policing activity by the Technical Director ceased (Phase IV).
The total number of patients and percentage of patients with no indications for therapy fell progressively through Phases II and III and returned almost to baseline after policing activities were discontinued in Phase IV.
We believe that it is unlikely that any department can sustain the educational and supervisory input necessary to assure optimal conformance to published standards for oxygen therapy when all members are involved. Therefore, assigning one qualified person to manage oxygen therapy may be more successful than other approaches. Requiring all therapists to monitor conformance to standards for low-flow oxygen therapy is time consuming and less effective and limits the time that can be spent caring for patients with problems that respond favorably to other forms of respiratory therapy.
我们根据标准适应症（蓝十字/蓝盾医疗必要性指南），前瞻性地研究了确保为本机构住院患者提供氧气的策略。
在未进行特定干预的基线观察期（第一阶段）之后，治疗师被告知适当的氧气使用是一项管理目标和部门优先事项，技术总监和医学总监提供了强化指导和病例审查（第二阶段）。在第三阶段，鼓励治疗师继续确保符合指南，但指导、讨论和审查停止，技术总监负责所有氧气治疗决策。最后，技术总监的所有协同监管活动停止（第四阶段）。
在第二阶段和第三阶段，患者总数以及无治疗适应症的患者百分比逐渐下降，在第四阶段停止监管活动后几乎恢复到基线水平。
我们认为，当所有成员都参与时，任何部门都不太可能维持确保最佳符合已公布的氧气治疗标准所需的教育和监督投入。因此，指定一名合格人员管理氧气治疗可能比其他方法更成功。要求所有治疗师监测低流量氧气治疗标准的符合情况既耗时又效果不佳，并且限制了用于照顾对其他形式呼吸治疗有良好反应的患者的时间。
