Improving Supplemental Oxygen Documentation within Medicine for Older People

Introduction: Patient observations and corresponding National Early Warning Score (NEWS) are valuable components in the identification of patient deterioration. NEWS is particularly important in our older population, whereby presentation of acute illness can be atypical and non-specific. Oxygen saturation and subsequent supplemental oxygen requirement are fundamental components of the NEWS, predicting delirium development, critical care admission and inpatient mortality. Consequently, inaccurate recording has implications for patient safety.

Aim: To improve the accuracy of supplemental oxygen documentation in patient observations within medicine for older people.

Methodology: The FiO2 percentage documented on patient observations was compared to the FiO2 being administered. Accuracy was assessed for three days a week over three weeks across three wards. Questionnaires were distributed to staff within the department assessing confidence recording supplemental oxygen and barriers to accurate documentation. Conversion charts between FiO2 and L/min formats were then introduced and accuracy reassessed.

Results: At baseline, supplemental oxygen was documented incorrectly in 52% of patient observations. 40.5% of staff members reported feeling ‘not confident’ when documenting or interpreting supplemental oxygen using FiO2 percentage and 81% felt more confident using L/min format. The most frequent barriers were lack of teaching (89%) and lack of understanding (62%). Following the introduction of conversion charts a 9% increase in the accuracy of supplemental oxygen documentation was observed. 

Conclusion: Pre-intervention, correct documentation of supplemental oxygen was unsatisfactorily low given potential implications for patient safety. Post-intervention, improvement was seen however the level of incorrect documentation remains high. Further interventions are planned to improve this further.