Chapter 12: Respiratory care, CPR and blood transfusion
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Clinical governance
Competencies
NHS Improvement ([181]) highlights the concerns surrounding delivery of oxygen therapy via cylinders. The valve mechanism in place to address fire prevention has led to an unintended consequence in that staff may believe oxygen is flowing when it is not. It has also been reported that staff have been unable to turn the oxygen flow on in an emergency. In a recent 3‐year period, over 400 incidents involving incorrect operation of oxygen cylinder controls were reported to the National Reporting and Learning System (NHS Improvement [181]).
It follows that nursing staff must be adequately trained to administer oxygen therapy and their competency should be assessed. They should check and document that a device is being used appropriately and that the flow and/or concentration of oxygen is as prescribed and appropriate to the patient's need (O'Driscoll et al. [209]).
Nursing and physiotherapy staff may assess patients and may initiate and monitor oxygen therapy within the prescribed parameters; an exeception to this would be in an emergency, when oxygen should be given first and prescribed later (Dhruve et al. [65]).
Governance
Clinical governance leads should audit current practice and develop local policies and evidence‐based guidelines (Dixon and Jones [66]) to ensure that:
- oxygen is administered and prescribed according to national guidance from the British Thoracic Society (O'Driscoll et al. [209])
- all equipment is regularly checked for safety
- staff are adequately trained to use equipment and troubleshoot it when problems occur.
Risk management
The use of medical equipment relating to oxygen therapy should be monitored as identified within local medical equipment policies. All incident reports relating to oxygen therapy and equipment should be reviewed by local risk management committees to identify themes and trends, and propose appropriate risk reduction measures to prevent reoccurrence and improve patient safety (MHRA [159]).
