1 Home Oxygen Service - Assessment and Review (HOS-AR) Janice Quarton Advanced Nurse Specialist Respiratory Medicine

2 What is HOS-AR? Provision of a systematic integrated oxygen service Provision of easy access to assessment and follow up procedures via appropriately qualified and trained healthcare professionals using appropriate diagnostic equipment

3 What is HOS-AR? Reduce/eliminate waste and poor quality care, strengthen affordability and value, through targeting the service on those who will benefit from home oxygen Ensure a higher standard of clinical treatment and improved outcomes, through more effective and speedier diagnosis Provide the users with a positive experience of care

4 Why Do We Need It? Oxygen service review in 2010 identified 85,000 patients in England on oxygen at a cost to the NHS of £110 million a year Between 24 and 43% of oxygen prescribed is either not used or does not give any clinical benefit Oxygen is charged for each patient whether used or not

5 Aim of HOS-AR Have quality at its core i.e. be accessible, safe and responsive to patients Be evidenced based, clinically led and continually strive to improve outcomes for patients Be affordable and represent good value for money

6 Change in Oxygen Contracts May 2012 new oxygen contracts came into use and changes in access to HOOFs occurred Non specialists can only access limited oxygen equipment via HOOF A Specialists now have responsibility for choosing the equipment for the patients A change in the way charges are applied was introduced

7 Local HOS-AR Meetings between CCG and secondary care to develop service specifications Agree referral pathways Develop referral proforma Recruit appropriately trained nurses to deliver service Develop a service operational policy

8 Local HOS-AR Provide education to both primary and secondary healthcare professionals regarding the role of oxygen and the service Organise locations across the CCG for provision of assessment Develop an effective and active register of all oxygen patients identifying areas for review and ongoing assessment

9 Local HOS-AR Inclusion/Exclusion Inclusion –Adult patients with oxygen saturations ≤92% breathing air –Patient is clinically optimised in primary care –Treatment for end of life care if patient is hypoxaemic –Completed referral form

10 Local HOS-AR Inclusion/Exclusion Exclusion –Patients under 18 years –A non-hypoxaemic breathless patient –SpO2 >92% –Patients that smoke –Patients who have not been clinically stable for 6 weeks –The above may not be an exhaustive list anad consideration will be given in individual circumstances

11 Key Messages Oxygen is not a treatment for breathlessness Do not issue oxygen when resting SpO2 is >92% Refer patients to the HOS-AR team for assessment –Therapeutic oxygen via Choose and Book –Palliative oxygen via clinician to clinician discussion and faxed referral form

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