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Audit of oxygen administration to achieve a target oxygen saturation range in acutely unwell medical patients
  1. James Harper1,2,3,
  2. Nethmi Kearns1,2,
  3. Grace Bird1,2,3,
  4. Robert McLachlan1,2,
  5. Allie Eathorne1,
  6. Mark Weatherall4,
  7. Richard Beasley1,2,3
  1. 1Medical Research Institute of New Zealand, Wellington, New Zealand
  2. 2Capital and Coast District Health Board, Wellington, New Zealand
  3. 3Victoria University of Wellington, Wellington, New Zealand
  4. 4University of Otago, Wellington, New Zealand
  1. Correspondence to Dr James Harper, Medical Research Institute of New Zealand, Wellington 6021, New Zealand; james.harper{at}mrinz.ac.nz

Abstract

Purpose of the study To evaluate documentation of a target oxygen saturation (SpO2) range and ability to achieve this range in acutely unwell inpatients.

Study design In this single-centre audit, patients with discharge diagnoses of pneumonia, heart failure and exacerbation of asthma or COPD admitted to Wellington Regional Hospital, New Zealand between 1 June 2019 and 31 August 2019 who received oxygen were identified. In those with a documented target SpO2 range, the proportion of SpO2 measurements in the observation chart which were within, above and below range were determined as well as the maximum and minimum SpO2. Regression analysis was performed to determine whether these outcomes were influenced by the prescribed range, high-dependency care or the number of adjustments to oxygen administration.

Results 268 admissions were screened. Of the 100 eligible admissions who received oxygen, a target SpO2 range was documented in 62. The mean (SD) proportion of SpO2 measurements within range was 56.2 (30.6)%. A hypercapnic target SpO2 range was associated with a higher probability of an SpO2 above range; multivariate OR 5.34 (95% CI 1.65 to 17.3, p=0.006) and a lower probability of an SpO2 below range; multivariate OR 0.25 (95% CI 0.08 to 0.80) p=0.02. The mean (SD) maximum SpO2 was similar in those with a target range of 92%–96% versus a hypercapnic range; 96.2 (3.0)% and 95.2 (3.4)%, respectively.

Conclusions Oxygen prescription and delivery in this clinical setting was suboptimal. SpO2 values above the designated range are common, particularly in patients with a hypercapnic target range.

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Footnotes

  • Contributors JH and RB designed the audit. JH, NK, GB and RM collected data. AE and MW performed the statistical analysis. All authors contributed to drafting the manuscript; JH wrote the first draft.

  • Funding The Medical Research Institute of New Zealand receives Independent Research Organisation funding from the Health Research Council of New Zealand (IRO grant (18/002)).

  • Competing interests RB reports a grant from Fisher and Paykel Healthcare outside the submitted work. JH reports personal fees from Fisher and Paykel Healthcare outside the submitted work.

  • Patient consent for publication Not required.

  • Ethics approval The audit was approved by the local clinical audit review committee. Ethical approval was not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article.

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