1. Anna Blackburn Oxygen Lead for the Project Consultant Physician James Paget University Hospitals NHS Foundation Trust

3. Aims of unified drug chart Safety be design features Keep it simple Avoid repetition (do it once) Translatable to e-prescribing Regional buy-in

4. Aim of oxygen prescription (BTS) Identify target oxygen saturation Keep the patient within their target range BTS markers of good practice Prescribe oxygen (doctor) Sign that oxygen has been checked on the drug round (nurse) Achieve oxygen saturation within the target range

6. NNUH & JPUH

7. JPUH / Generic model

8. NNUH Model √ Safety be design features × Keep it simple × Avoid repetition (do it once) × Translatable to e-prescribing × Regional buy-in

9. Oxygen Prescribing / Administration Oxygen is a drug Oxygen is one of the most common drugs used in secondary care Generalists (and surgeons) must feel able to prescribe and administer oxygen safely

10. Trial version 1

11. Trial 1 feedback Did the chart change the way you review oxygen on the drug round? JPUH: Yes x 6 NNUH: No x 7 Were your drug rounds longer? JPUH: Yes x 6 (doing additional obs on round) NNUH: No 6 Yes x 1 Was it easy to understand & use? JPUH: Yes x 6 NNUH: Yes x 3 No x 4 Do you think it will improve patient outcomes? JPUH: Yes x 6 NNUH: Yes x 1; No x 4: Not sure x 2 Very simplistic There should be space to write down the amount of oxygen the patient is on Which chart do you prefer & why? JPUH: Trial x 5; Current x 1 Encourages appropriate oxygen titration NNUH: Trial x 1; Current x 6 Can visualise trend in sats Can record changes & recheck Suggestions Hand pulse oximeter for drug round (JPUH)

12. Trial 1 – Outcomes (Resp wards)

13. Trial version 2

14. Feedback on PDSA trial charts NNUH “This is a retrograde step. Please keep the current model. The proposed change will add to clinical burden and is not user friendly” AMU Consultant “The chart we already use is perfect” Staff nurse JPUH Split between V1 & 2 but definitely prefer it to current chart

15. Trial 2 – Outcomes (Resp wards)

16. Trial version 3 Campaign for plain English!

17. Trial 3 – Outcomes (mixed wards)

18. Compromise… Plain English Shift away from BTS universal codes for fixed percentage oxygen

19. Feedback so far Via Survey Monkey “No initial flow rate/%age” “Very complex” Shop-floor feedback Easy to understand Time-consuming Repetition

21. Unified drug chart – next phase E-learning package with App Transferrable across the region Initial training Refresher Targeted training