Reducing inappropriate oxygen use in hospitalized medicine patients

ABSTRACT

Introduction

Evidence suggests inappropriate oxygenation may be harmful to patients. To improve oxygen use in our hospital, we initiated a quality improvement project with a goal to reduce the percentage of inappropriate utilization of oxygen by 50% within a year.

Methods

Nasal cannula (NC) oxygen use data for medicine inpatients was abstracted weekly for chart review. A multidisciplinary team developed a guideline for use. Initiation of NC O2 with a baseline SPO2 > 92% was deemed inappropriate and 3+ consecutive SPO2 > 96% was defined as over-supplementation. Formal interventions included an oxygen use guideline, updated EMR order, unit-specific feedback, and magnetic placards. Progress was tracked by control charts.

Results

Baseline data revealed 40% of patients were inappropriately placed on oxygen and 55% of patients had one instance of excessive supplementation. Only half of all improper uses of oxygen had charted medical reasoning, and 30% had a corresponding order. Instances of proper oxygen use had orders 48% of the time. Run charts revealed inappropriate initiation was significantly reduced to 27.1% (p < 0.0001) and excessive oxygenation decreased significantly to 34.4% (p < 0.0001) following interventions with no effect on other variables.

Conclusions

Our interventions significantly decreased improper oxygen initiation and excessive supplementation.

KEYWORDS:

• Hospital inpatient
• quality improvement
• oxygen
• waste reduction
• Nasal Cannula

Acknowledgments

Special thanks to members of our multidisciplinary team including Anna Beckius, Nathan Bopp, Jeanette Carreras, Katie Gehrig, Amanda Kalupa, Michael Pierro, Matthew Weber, and Brett Zemplinski.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/21548331.2023.2241341

Declaration of financial/other relationships

G Lamb holds the position of vice chair of quality in the Department of Medicine and is employed at Froedtert Hospital. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

G Lamb conceived the project ideal and developed the concept. E Daniels submitted the proposal and organized the initiation of the project. E Daniels and A Beckius participated in data abstraction and data analysis. A Beckius performed statistical analysis and created chart graphics. E Daniels ran primary group meetings. The manuscript was written with E Daniels as primary author with editing by G Lamb and final review by A Beckius.

Additional information

Funding

This paper was initiated under the Medical Student Summer Research Program (MSSRP) at the Medical College of Wisconsin and sponsored by the Collaborative for Healthcare Delivery Science, which is funded by the Advancing a Healthier Wisconsin Research & Education Program and MCW’s Dean’s office.