NHS Borders PGD, Oxygen 1

This Patient Group Direction is for the administration of Oxygen to patients receiving treatment from NHS Borders within the Emergency Department,

Minor Injuries Units and Out of Hours Services.

This document authorises the supply or administration of Oxygen by registered nursing staff to patients who meet the criteria for inclusion under

the terms of the document

The registered nurse seeking to supply Oxygen must ensure that all clients have been screened and meet the criteria before supply takes place

The purpose of this Patient Group Direction is to provide immediate therapy for critically ill patients in NHS Borders by registered nursing staff

PGD previously approved: 01/06/2006 This direction was authorised on: April 2013 The direction will be reviewed by: April 2015 Clinician Responsible for Training and Review: Emergency Department Consultant PGD Reviewed by: Jacques Kerr (Emergency Department Consultant)

NHS Borders PGD, Oxygen 2

Patient Group Direction for administration of Oxygen without a prescription for a named individual by registered nurses employed by NHS Borders. 1. This Patient Group Direction relates to the following specific preparation: Name of medicine, strength, formulation

Oxygen

Legal status General Sales List (GSL)

Storage Warning notices prohibiting smoking and naked lights must be posted clearly in the cylinder storage area. (Care is needed when handling and using medical oxygen cylinders. For full storage requirements see section 3c.)

Dose(Oxygen flow rate) Initial flow rate is 15 l/min via a reservoir mask.

Route/method Inhalation

Advice to Patients

Avoid naked flames and explain hazards of smoking.

Relevant Warnings Medical oxygen toxicity can occur as manifested by:

• retrolenticular fibroplasia in premature infants exposed to oxygen concentrations greater than 40%

• convulsions appear after a few hours exposure to medical oxygen at pressures above 3 bar(g)

• retrosternal soreness associated with coughing and breathing difficulties, made worse by smoking and exposure to cold air after breathing pure oxygen at atmospheric pressure for several hours.

Follow up Arrangements

MIU or OOHs - transfer to hospital via paramedics. Emergency Department - immediate medical review. All patients commenced on Oxygen will require medical review.

NHS Borders PGD, Oxygen 3

2. Clinical condition: Clinical Condition to be treated

• Immediate therapy for all critically ill patients at a rate of 15 l/min through a reservoir mask

• Aim for saturations of 94-98% for most acutely ill patients or 88-92% for those at risk of hypercapnic respiratory failure

* See British Thoracic Society (BTS) guideline for emergency oxygen use in adult patients.

Criteria for inclusion

• Therapy for all patients with respiratory failure.

• All patients with acute asthma • All patients with acute anaphylaxis • All patients with any type of shock

Criteria for exclusion

None during emergency resuscitation.

Action if excluded • The patient must be reviewed by a doctor. The reason for referral should be documented.

• It is the responsibility of the registered nurse using this PGD to ensure that treatment with the drug detailed in this direction is appropriate. If in any doubt, advice should be sought and recorded before the oxygen is administered.

Action if declines The patient must be reviewed by a doctor. The reason for referral should be documented.

Interactions with other medicaments and other forms of interaction

None

3. Documentation/Record keeping. a) The following records should be kept (either paper or computer based)-

The GP practice, clinic, hospital, and ward or department The patient name and CHI number The medicine name, dose, route, time of dose(s), and where appropriate, start date, number of doses and or period of time, for which the medicine is to be supplied or administered Drug batch number and expiry The signature and printed name of the healthcare professional who supplied or administered the medicine The patient group direction title and/or number Whether patient met the inclusion criteria and whether the exclusion

NHS Borders PGD, Oxygen 4

criteria were assessed Quantity supplied / received and

• stored upright under cover, preferably inside in a well ventilated area, kept dry and clean and not subjected to extremes of heat and away from stocks of combustible material

current stock balance b) Preparation, audit trail, data collection and reconciliation-

Stock balances should be reconcilable with receipts, administration, records and disposals on a patient by patient basis.

c) Storage- Liquid medical oxygen cylinders should be:

• stored separately from industrial and other non-medical cylinders • stored to maintain separation between full and empty cylinders • used in strict rotation so that cylinders with the earliest filling date are

used first • stored separately from other medical cylinders within the store.

4. Professional Responsibility.

• All Health Professionals will ensure he/she has the relevant training and is competent in all aspects of medication, including contra-indications and the recognition and treatment of adverse effects.

• He/she will attend training updates as appropriate. • For those involved in immunization, regular anaphylaxis updates

are mandatory. • Nurses will have due regard for the NMC Code of Professional

Conduct, standards for conduct, performance and ethics (2008) and NMC Standards for Medicines Management (2008)

• In service training in use of medical gases including Oxygen.

5. References • British Thoracic Society (BTS) Guideline for emergency oxygen use

in adult patients. Accessed at: http://www.brit-thoracic.org.uk/Portals/0/Clinical%20Information/Emergency%20Oxygen/Emergency%20oxygen%20guideline/THX-63-Suppl_6.pdf

• Medical Oxygen SPC. Accessed at: http://www.bocsds.com/uk/sds/medical/medical_liquid_oxygen.pdf

• British National Formulary (BNF) current edition http://bnf.org/bnf/index.htm

• British National Formulary (BNF) Children edition http://bnfc.org/bnfc/bnfc/current/

• Borders Joint Formulary (BJF) http://intranet/new_intranet/microsites/index.asp?siteid=65&uid=1

Patient Group Direction for provision and/or administration of Oxygen byhealth professionals employed by NHSBorders

ThisPatient Group Direction is approved for use by the under-signed:

Job Title Name Signed Date

Senior Doctor for relevant Sheena MacDonald ~~~ VVl/k- ~71'bJiKclinical area

-

NHSBorders Director of Alison Wilson LV. {.~ s/);/lt-Pharmacy Vv'"

NHSBorders Senior Evelyn Fleck e-~ 2X1211~ .Health Professional forClinical Area

12 .~ \~P~D AUTHORISED ON ........ / ..••.•. / .... ~~Signed by ADTC CHAIRPERSON:............................... ~..........................Name: ... Karen McNicoll. ................................................................. ~.

The Health Professloncls named below, being employees of NHSBordersare authorised to provide and/or administer this medication under thisPatient Group Direction and agree to provide and/or administer this

medication in accordance with this Patient Group Direction

Name of Health Professional Job Title Signed Date

~

~-.

NHS Borders PGD, Oxygen 5