Implementation of an advanced practice role for oxygen prescription by physiotherapists in pulmonary rehabilitation: an explanatory sequential mixed-method quality evaluation.

Background Physiotherapists play a key role in the administration of supplemental oxygen during physical activity in pulmonary rehabilitation. However, supplemental oxygen requires a medical prescription making processes cumbersome for physiotherapists. This study aimed to implement and evaluate an advanced practice role for physiotherapists (APO2) allowing them to prescribe oxygen during physical activity. Methods Training and certification process for respiratory physiotherapists employed in an inpatient rehabilitation clinic was implemented. A mixed-method approach for retrospective evaluation was used. Quantitative analysis included routine clinical data from oxygen prescriptions, titrations, and exercise capacity. Additionally, healthcare professionals' experiences and perceptions of the new APO2 role was explored using a survey. Qualitative data included interprofessional interviews, survey comments, and data from the critical incidence reporting system. Results In 15% of patients during the evaluation period, certified APO2 were involved in oxygen prescription. These patients had more frequent titrations (median 8 [interquartile 6, 10] vs. 5 [4, 8]), prescription adjustments (3 [2, 4] vs. 1 [1, 2]), and narrower oxygen dosage ranges prescribed (2 [1, 3] vs. 4 [3, 4]). No significant difference in exercise capacity was observed and no adverse events reported. Survey data from 19 healthcare professionals and interviews indicated that the specialised expertise of APO2 positively impacts interprofessional collaboration and workflow efficiency. Conclusions Physiotherapy-led oxygen prescription during physical activity in pulmonary rehabilitation is feasible, safe, and perceived as beneficial for the workflow and interprofessional collaboration across healthcare professions. Trial Registration According to Swiss law (Human Research Act, Art. 2), ethics approval for the study and informed consent were not required and were waived off. All methods were in accordance with the regulations and guidelines of the Swiss Human Research Act and Swiss ethics law.