Choudhury Aklak, Young Gregor, Reyad Beshoy, Shah Nirali, Rahman Radhea
Department of Respiratory Medicine, Barking, Havering and Redbridge University Hospitals NHS Trust, Queen's Hospital, Romford, UK.
BMJ Open Qual. 2018 Oct 15;7(4):e000371. doi: 10.1136/bmjoq-2018-000371. eCollection 2018.
The British Thoracic Society recommends oxygen delivery to achieve target oxygen saturation range between 94% and 98% for medically unwell adult patients, and 88% to 92% in patients at risk of hypercapnic respiratory failure. Interviews with our medical and nursing staff suggested that oxygen was sometimes being given to patients without a valid order and there was a failure to titrate oxygen to the stated oxygen saturation range. Our aim was to improve appropriate oxygen delivery to 90% of our patients on a 30-bedded respiratory ward within 3 months. We identified several key steps to safe oxygen delivery on our ward. These include the recording of target oxygen saturation range, the prescribing of an oxygen order on drug chart and the correct bedside delivery of oxygen to the patient. To help improve compliance of these key steps, the following plan-do-study-act (PDSA) interventions were undertaken: (1) Educational announcements at board rounds. (2) A communication oxygen poster. (3) Highlighting improvement progress to teams via email. (4) Pharmacist review of inpatient drug chart. (5) Display of target oxygen saturation range at patient bedside. At baseline, only 50% of drug charts had a recorded oxygen order and 60% of drug charts had a set target oxygen saturation range. Following PDSA interventions, both measures improved to 93%. Our main outcome measure of appropriate oxygen delivery to the patient improved from a baseline of 20% to 80% on completion. Our quality improvement programme has shown simple interventions can improve oxygen prescribing and appropriate delivery of oxygen to the patient. The most effective PDSA interventions were sharing our measurements via email and displaying target oxygen saturation ranges by the patient bedside. We aim to provide future oxygen educational sessions at induction to our staff and scale our quality improvement programme to other wards including our acute medical unit.
英国胸科学会建议，对于病情不稳定的成年患者，应提供氧气以使血氧饱和度达到94%至98%的目标范围；对于有高碳酸血症呼吸衰竭风险的患者，血氧饱和度应维持在88%至92%。对我们的医护人员进行访谈发现，有时在没有有效医嘱的情况下就给患者吸氧，而且未能将氧气滴定至规定的血氧饱和度范围。我们的目标是在3个月内，将一个拥有30张床位的呼吸病房中90%的患者的氧气供应调整至合适水平。我们确定了病房安全供氧的几个关键步骤。这些步骤包括记录目标血氧饱和度范围、在药物图表上开具吸氧医嘱以及在床边正确地给患者供氧。为了帮助提高对这些关键步骤的依从性，我们采取了以下计划-实施-研究-改进（PDSA）干预措施：（1）在查房时进行教育宣传。（2）张贴氧气使用说明海报。（3）通过电子邮件向各团队强调改进进展。（4）药剂师审查住院患者的药物图表。（5）在患者床边显示目标血氧饱和度范围。在基线水平时，只有50%的药物图表记录了吸氧医嘱，60%的药物图表设定了目标血氧饱和度范围。经过PDSA干预后，这两项指标均提高到了93%。我们为患者提供合适氧气供应的主要结果指标从基线时的20%提高到了完成干预后的80%。我们的质量改进计划表明，简单的干预措施可以改善氧气处方的开具以及向患者提供合适的氧气供应。最有效的PDSA干预措施是通过电子邮件分享我们的测量数据以及在患者床边显示目标血氧饱和度范围。我们的目标是在新员工入职培训时提供未来的氧气教育课程，并将我们的质量改进计划推广到其他病房，包括我们的急性内科病房。
