Guidelines on home use of oxygen
The latest policies and what they mean for healthcare professionals.
All patients considered for long-term oxygen treatment at home should have a thorough risk assessment including risk of fire, trips and falls, according to new national standards.
Carrying out a risk assessment is one of ten standards listed by the British Thoracic Society (BTS) in Quality Standards for Home Oxygen Use in Adults.
The document is intended to be referred to by nurses and other healthcare professionals, NHS commissioners, and patients to ensure the best possible clinical care for people on oxygen at home.
In England, about 85,000 patients receive oxygen at home, generally for heart and lung conditions that cause low blood oxygen levels, such as chronic obstructive pulmonary disease (COPD).
Receiving oxygen at home can improve people's quality of life and can increase life expectancy.
The smoking status of patients and other household members should be recorded, with safety advice and smoking cessation support offered. This is due to the significant risk of fire if oxygen is used when patients or others around them are smoking or vaping.
The BTS sets out standards to ensure that patients are referred promptly for assessment for home oxygen, as well as the reviews and checks that should take place regularly for those receiving the treatment.
It also calls for all patients started on home oxygen to have appropriate education and written information provided by a specialist home oxygen assessment team.
Those who receive no formal education about their care are often poorly compliant with their oxygen regimen in the long term.
Short-burst oxygen therapy should be provided only to those with cluster headaches, not to patients with chronic cardiorespiratory disease, the BTS states.
Palliative oxygen therapy can be considered as a trial for patients with hypoxaemia and breathlessness due to life-limiting disease that has not responded to opioids or non-drug measures.
Implications for nurses
All patients with severe COPD should have their oxygen saturation documented at least twice a year in primary care so that they can be referred to a home oxygen service when appropriate.
Patients being considered for home oxygen therapy should have serial blood gas assessments when stable to check if they are suitable.
Once oxygen treatment has started, patients should receive a blood gas review after three months to see if the treatment is working and whether it should be continued.
There should be regular ongoing checks by a home oxygen assessment service on at least an annual basis.
Vikki Knowles, respiratory nurse consultant for Guildford and Waverley Clinical Commissioning Group and representative of the Primary Care Respiratory Society UK
‘Home oxygen can improve quality of life and life expectancy, but only in patients with chronic hypoxaemia.
‘These standards should help nurses and other staff ensure that the right people are assessed at the right time – when their condition is stable – by a home oxygen assessment service so that those who will benefit can get treatment.
‘However, access to home oxygen assessment teams remains variable around the country. One misconception among many healthcare staff is that oxygen can help with breathlessness.
‘Oxygen can only treat hypoxaemia and giving it to patients who are breathless could prevent them from getting the most effective treatment.
‘The standards also spell out that short-burst oxygen should not be given for respiratory conditions.
‘These quality standards are based on the best evidence and should help nurses give the best care.’
Find out more
British Thoracic Society
National Institute for Health and Care Excellence
Nursing Older People
- Wrench C, Darwin R, Lawson R (2015) Redesigning a home oxygen assessment and review service