Improving Compliance With Valid Oxygen Prescriptions for Surgical Inpatients in a District General Hospital: A Single-Centre Quality Improvement Study

Introduction Medical oxygen is a drug and, as such, must be correctly prescribed according to British Thoracic Society (BTS) guidelines. These guidelines state that a valid prescription must include a target oxygen saturation range, and that all inpatients should have a valid oxygen prescription. A 2008 BTS audit revealed only 32% of patients receiving oxygen had valid prescriptions, and a 2015 re-audit showed improvement to 57.5%, still below the national 95% target. Unregulated oxygen administration can lead to complications such as hypoxia, hyperoxia, and increased healthcare costs. Our quality improvement project (QIP) aimed to improve adherence to BTS guidelines on two general surgical wards at Royal Blackburn Teaching Hospital, aiming for complete adherence. Methods A quality improvement study was conducted using electronic patient records (EPRs). In the baseline audit, data was collected on patients over a one-week period. Thirty-three patients were included, with information on age, oxygen prescriptions, and Chronic Obstructive Pulmonary Disease (COPD) status recorded. Four interventions were then implemented: the addition of reminders to handover sheets, visual prompts around the ward, announcements during nursing huddles, and WhatsApp reminders to the ward doctors. A re-audit was conducted after the interventions, including 31 patients, and data was compared using the Chi-squared test. Results In the baseline audit, 18% of patients had oxygen prescribed. Following the interventions, this rose to 54.8% (χ²(1, N=64) = 9.3, p < 0.01), and as such, was statistically significant. Among patients requiring oxygen, compliance improved from 0% to 90.9%. Discussion The interventions significantly improved oxygen prescription compliance, demonstrating the effectiveness of simple, targeted measures. The inclusion of the multidisciplinary team (MDT) was crucial, as both nurses and doctors play essential roles in oxygen delivery. However, compliance remained below the BTS target of 100%. Limitations include not assessing the impact of individual interventions and analyzing only two points in time. Future audits should focus on targeting prescribers early in admissions and integrate electronic systems for automated prescription prompts. Spot audits could help ensure long-term success. Conclusion This QIP improved compliance with BTS oxygen prescribing guidelines at Royal Blackburn Teaching Hospital, from 18% to 54.8%. Engaging the MDT and using reminders increased compliance, but further efforts are needed to achieve the 100% target. Future interventions should focus on EPR integration, ongoing education, and further audit cycles for sustained improvement.