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Oxygen may be a life-saving therapy and is an important aide in the treatment of various conditions (Figure 1). Oxygen can, however, cause dangerous effects (Figure 2); it should be considered a drug and therefore only be available by prescription.
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Figure 1. American College of Chest Physicians and National Heart, Lung, and Blood Institute recommendations for instituting oxygen therapy.1
* Cardiac and respiratory arrest
* Hypoxaemia (PaO2<7.8 kPa, SaO2<90%)
* Hypotension (systolic blood pressure <100 mmHg)
* Low cardiac output and metabolic acidosis (bicarbonate <18 mmol/L)
* Respiratory distress (respiratory rate >24/min)
It is generally accepted that in order to ensure safe and effective treatment, oxygen prescriptions should cover the flow rate, concentration, delivery system, duration, and monitoring of treatment.1 It is, however, recognised that oxygen is poorly prescribed by doctors.1
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Figure 2. Dangers of oxygen therapy.1,2
* Respiratory system toxicity (e.g. tracheobronchitis, absorption atelectasis, bronchopulmonary dysplasia, acute and chronic parenchymal lung injury)
* Maladaptive physiologic response and hypercapnia in patients with chronic obstructive pulmonary disease
* Nonmedical adverse effects (e.g. fire hazards)
* Paul-Bert effect (hyperbaric oxygen causing severe cerebral vasoconstriction and epileptic fits)
A previous study,3 conducted in Manchester, England, showed that only 55% of inpatients receiving oxygen therapy had it prescribed. After introduction of a specific oxygen prescription chart, this oxygen prescription rate rose to 91%.
Another study,4 conducted in 1992 in Christchurch, New Zealand, showed that one third of inpatients receiving oxygen did not have it prescribed. A further study,5 conducted in Sunderland, England, showed that only 16% of inpatients receiving oxygen therapy had it prescribed. Additional studies have shown that oxygen is not prescribed and administered with the same procedural care as other medications,6 and that oxygen therapy is often administered excessively.7
Waitemata District Health Board Clinical Practice Guidelines clearly state that the assessment of oxygen requirement and the prescription of oxygen should only be carried out by medical staff. However, in an emergency and for patient safety, the Guidelines allow oxygen to be initiated by a nurse or midwife while the patient is awaiting medical assistance.
When administered correctly, with careful evaluation of its potential benefits and side effects, oxygen may be life-saving. It is clear, however, that oxygen is often...