1. SAFE PRACTICE IN HOME OXYGEN THERAPY
NURSING/CARE/RESIDENTIAL HOMES | HOSPICES | SCHOOLS
31/10/16 l Evan Williams l Respiratory Advisor

2. Outline GDP Examples of Inappropriate Practice Oxygen Safety
Definition
Home Oxygen Ordering
Typical Equipment
Roles & Responsibilities
Examples of Inappropriate Practice
Oxygen Safety
Storage
Use & Administration

3. GDP - Good Distribution Practice
Definition & Responsibilities

4. GDP and Oxygen Good Distribution Practice
OXYGEN IS LISTED IN THE BNF AS A DRUG
WHEN WAS THE LAST TIME YOU TOOK A MEDICINE?
DID YOU TAKE IT FOR GRANTED?

5. How is Home Oxygen Ordered?
SPECIALIST CLINICAL ASSESSMENT
LTOT – blood gas analysis
AOT – walking test
SBOT – cluster headaches
HOOF and HOCF filled in by Healthcare Professional
HOOF completed online and sent electronically to Air Liquide (Homecare) Ltd
Air Liquide receives HOOF and processes it according to the prescriber’s instructions
Air Liquide arranges delivery of the Home Oxygen equipment with the patient
Patient contacts Air Liquide for refills and reports faults if they occur

6. Typical set up for patient requiring LTOT and AOT
AirSep® NewLife® Concentrator Low Flow (0.5L/min) Elite (1-5 L/min) Intensity (2-8L/min) Back Up Cylinder (10 Litre) To supply at least 8 hours of oxygen ONLY to be used in the event of a mechanical fault and/or power failure Portable cylinders (2 Litre) For ambulatory use only
There are several different types of static and portable cylinders They all look similar to each other, but deliver a range of flow rates Please ensure cylinders are labelled and used for that named patient only

7. So What is Good Distribution Practice?
It is a quality system for ensuring that medical products are consistently stored, transported and distributed under suitable conditions
It is designed to ensure that the quality of a medical product is maintained and that the product remains traceable
It is a legal requirement to comply with GDP when storing and handling medical gases
It covers all aspects of storage, transport and distribution from the receipt and storage of medical products, the premises, the training of staff to the delivery of the medical product to the customer
It requires adherence to detailed written procedures for each process that could affect the quality of the delivered product
GDP PROTECTS THE SAFETY & WELLBEING OF PATIENTS

8. Who is responsible for Good Distribution Practice?
All of us are responsible for GDP
Qualified Person (Q.P.)
Ensures the conditions of the licence are met
Ensures GDP is followed
Ensures the quality system for the storage and distribution of medicinal products is implemented and maintained
Safeguards patients against the potential hazards arising from poor distribution practices
Nursing Homes / Care Homes / Hospices / Schools have a responsibility to ensure our oxygen is administered correctly to the named patient

9. Who is responsible for Good Distribution Practice?
Care workers may administer prescribed medication (including controlled drugs) to another person with their consent, provided this is done in accordance with the prescriber’s directions (The Medicines Act 1968)
Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 12 ‘Safe Care & Treatment’
1) “Care and treatment must be provided in a safe way for all service users”
2) “…the things which a registered person must do to comply includes:”
2e) “ensuring that the equipment used by the service provider for providing care or treatment to a service user is safe for such use and is used in a safe way;”
2g) “the proper and safe management of medicines”

10. Who is responsible for Good Distribution Practice?
Care Quality Commission (CQC)
the independent regulator of health and adult social care in England
ensure health and social care services provide people with safe, effective, compassionate, high-quality care and to also encourage improvements
monitor, inspect and regulate services to make sure they meet fundamental standards of quality and safety and publish what they find to help people choose care
“CQC can prosecute for a breach of this regulation or a breach of part of the regulation if a failure to meet the regulation results in avoidable harm to a person using the service or if a person using the service is exposed to significant risk of harm” (Regulation 12: Safe Care and Treatment, CQC website)
In 2013 CQC fined Selby care home £8,000 for failure to meet medication regulations. CQC Director stated:
“It is a provider’s legal duty to ensure that it has appropriate arrangements in place to manage medicines in a safe way” (CQC website)

11. Examples of Inappropriate Practice

12. Examples of Inappropriate Practice
Giving oxygen that has been ordered for one patient on a HOOF to somebody else for emergency or temporary use
Patient A has a concentrator with back up (BU) cylinder and 2 x portable cylinders
Other residents use the BU cylinder for emergencies whilst they wait for an ambulance:
Patient A is now without BU and at risk if their concentrator or electricity supply fails
Staff decide to give Patient A’s portable cylinders to Patient B who becomes breathless when walking to the bathroom and to move around the home:
Patient B is a CO2 retainer and becomes apnoeic due to administration of high flow oxygen
Patient A has no cylinders to meet their oxygen prescription
Sharing oxygen equipment between residents is not permitted
Care facilities should purchase/rent large cylinder(s) if required for emergency use only and should be administered under a written clinical protocol
The urgent need for oxygen supply would need to be assessed by medically trained staff (UK Medicines Information, February 2015)
NHS home oxygen must be ordered on a HOOF and used for that named patient only
Specialist assessment is needed for LTOT or AOT

13. Sharing oxygen equipment between residents is not permitted
Examples of Inappropriate Practice
Using oxygen equipment named for someone on a HOOF who has since passed away or no longer requires it clinically
Home oxygen was ordered for that patient only
All equipment for that named patient must be removed
Sharing oxygen equipment between residents is not permitted
A removal request must be sent to Air Liquide as soon as the oxygen equipment is no longer required (RIP / clinical reason)
Billing to the CCG will stop immediately upon receipt of removal request and the Technician will contact you to arrange removal
Specialist assessment is needed for LTOT or AOT

14. Examples of Inappropriate Practice
Altering equipment such as adding extra tubing
Following installation of oxygen, patient’s requirements have changed and he/she would now like to access the common room
Tubing provided at the time of the risk assessment and installation is now not long enough to meet the patient’s needs
Somehow, staff acquired additional tubing to extend the length of tubing that the patient had been given by Air Liquide Technician
This creates a further trip hazard and may lead to patient not receiving the correct flow rate
Maximum tubing length allowed is 15 metres
Patient needs to access other parts of the home, but you are not permitted to alter our equipment as you will be tampering with a medical device. Options?
Call Air Liquide and ask for Technician visit to review the tubing
Call oxygen prescriber to discuss any benefit to having a second concentrator

15. Oxygen Safety
Storage

16. Oxygen Safety - Storage
Fire Risks
Materials burn much faster in oxygen than in air alone
NEVER smoke or let anyone smoke near you while they are using
oxygen equipment
NEVER use the oxygen equipment near (within 3m) open fires
or naked flames
ALWAYS contact Air Liquide (Homecare) Ltd to tell us what oxygen
equipment was involved in the fire
NEVER use any oxygen equipment that has been involved in a fire or accident

17. Oxygen Safety - Storage
ALWAYS follow the advice given to you by your Homecare Technician about the safest place to store and use your oxygen equipment
ALWAYS ensure oxygen equipment is stored in a well ventilated area,
kept clean, dry and away from any sources of heat or fire e.g. convection
heaters, gas or electric fires, gas cookers etc
NEVER store oxygen equipment close to paint, oil, grease or any
domestic heating gases
NEVER keep combustible materials near oxygen equipment e.g.
newspapers, magazines, and other items that may burn easily
ALWAYS store the liquid oxygen unit upright
It is advisable to keep back up cylinders and cylinders not in use in a locked room with appropriate signage – easily accessible when required – key to be with staff in charge at every shift

18. Oxygen Safety
Usage & Administration

19. Oxygen Safety – Usage
Materials will become saturated or enriched with oxygen and may burn very quickly and fiercely if they catch fire
NEVER leave the cannulae or mask on the bed or chair when oxygen
equipment is switched on
ALWAYS turn off the oxygen equipment when not in use
BE AWARE of tubing as a potential trip hazard
NEVER use petroleum-based products (Vaseline) or other oil based creams to soothe a sore area around nose or mouth when using oxygen equipment ONLY use water based / soluble creams or products
NEVER share cannulae or masks between patients

20. Oxygen Safety – Administration
ALWAYS ensure you are only using oxygen equipment for the named patient. It might be advisable to label individual patient’s equipment
ALWAYS check the gauge to ensure there is sufficient oxygen
ALWAYS check the oxygen is reaching the patient
ALWAYS ensure oxygen is given in line with the prescription:
L/min and hours per day
Too much oxygen can be detrimental. Some people with respiratory conditions are ‘oxygen sensitive’ and have to use low flow rates or in some cases cannot use oxygen at all
These patient have a ‘hypoxic drive’ meaning their need to breathe is triggered by low oxygen levels. Giving too much supplemental oxygen can cause their respiratory rate to decrease or even stop!!
The only way of knowing this is by a formal oxygen assessment
Specialist assessment is needed for LTOT and AOT

21. Safe storage / use and to only ever administer to named patients
Summary
Everyone is responsible for GDP
Nursing/Care/Residential homes, Hospices, Schools and Nurseries have a legal responsibility to comply with The Medicines Act 1968
Nursing/Care/Residential homes, Hospices, need to comply with standards set out by CQC regarding medicines
Oxygen is a safe medicine when used in the correct way. Please remember:
Safe storage / use and to only ever administer to named patients

22. Thank you for your attention
End of presentation
Thank you for your attention