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DVD addresses risks of smoking near home oxygen

Patient's horrific death inspired innovation.

A patients death in November 2013 had a real impact on me. The 67-year-old man had been discharged from hospital in September on high flow oxygen at 8L/min, 24 hours per day. He would have died very quickly without it. He had pulmonary fibrosis, de-saturated to 70% on air.

At a home safety visit in October, a risk assessment was completed and the heavy smoker was given verbal and written information on the dos and donts of smoking near oxygen and telehealth was installed. He was given a fire-retardant blanket. We even fitted a sprinkler system. But we could not prevent him from continuing to smoke at home and the patient died following a fire. His screams of pain could be heard on telehealth a recording was played in the coroners court. I saw a picture of

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A patient’s death in November 2013 had a real impact on me. The 67-year-old man had been discharged from hospital in September on high flow oxygen at 8L/min, 24 hours per day. He would have died very quickly without it. He had pulmonary fibrosis, de-saturated to 70% on air.


Respiratory nurse specialist Julie Danby. Photo: Jim Varney

At a home safety visit in October, a risk assessment was completed and the heavy smoker was given verbal and written information on the dos and don’ts of smoking near oxygen and telehealth was installed. He was given a fire-retardant blanket. We even fitted a sprinkler system.
 
But we could not prevent him from continuing to smoke at home and the patient died following a fire. His screams of pain could be heard on telehealth – a recording was played in the coroner’s court. I saw a picture of his body.
 
At the inquest I heard what happened. He had been lying on an air mattress smoking near his oxygen therapy. He fell asleep and the cigarette caught on his blanket. He jumped in the shower, but collapsed on the floor. He became hypoxic quickly, but refused to leave the building as he did not want to be seen naked.
 
This death is one of a growing number of serious untoward incidents, from burns to fatalities, in Hull. Our city has the third highest number of city smokers in the UK and 600 patients are prescribed oxygen.

As the clinical lead for the home oxygen service I wanted to do more to prevent any further incidents.

These patients are often long-term smokers who have ignored decade's worth of promotional campaigns to quit. There are real dangers to smoking while using oxygen, and not just to the person smoking. I wanted to develop a hard-hitting film demonstrating those dangers to try to make the message sink in.
 
I also wanted to create a reource to help healthcare professionals prescribe appropriately and ensure we were all giving consistent messages. I wanted to highlight that we can prescribe oxygen, even if somebody smokes, if not prescribing it means the patient will return to hospital, or die. I wanted the film to help healthcare professionals balance those risks.
 
There was no existing product demonstrating the dangers. My management was supportive of my idea but said there was no budget to fund the initiative.
 
So I wrote the script and began a partnership with the Humberside Fire & Rescue Service, which was enthusiastic about the project, and students from Hull College Media Department, to produce the safety film. We all had a shared goal of safeguarding patients and the public.


Julie with the actor (her mum) playing the part of the patient. Photo: Jim Varney

We became actors and filming took place at three venues, including the fire station, where a controlled fire was initiated to demonstrate the effects oxygen has on a naked flame. Our oxygen contract rep gave us permission to blow up the company’s equipment.

The film aims to encourage patients to reflect and think about their use of home oxygen therapy and the decisions they make in relation to smoking and careless use of oxygen.  It highlights that the consequences of smoking near oxygen does not just affect on the smoker, but can have a devastating physical and emotional effects on loved ones.

I play the role of a nurse visiting a patient who is receiving oxygen at home, but continues to smoke. This leads to the death of her grandson – having devastating consequences for the patient and her family.


Julie worked with Humberside Fire & Rescue Service to produce the DVD. Photo: Jim Varney

It makes patients aware of the dos and don’ts of smoking or being near a source of heat while wearing their oxygen.

While the lack of funding was challenging, this was overcome by our mutual commitment, creativity and thinking out of the box. And my organisation’s culture made making change a positive experience for me.

Enthusiasm and commitment from all members of the team ensured momentum. The film took six months to be developed before being launched in home oxygen services throughout Yorkshire. 

All patients on oxygen and at risk are shown the film on tablets or laptops during home visits. It is used in pulmonary rehabilitation programmes and by smoking cessation services. You can watch the film by clicking here.

After the pilot, a patient information survey was completed within pulmonary rehabilitation. Local patients have given excellent feedback.


Patients are shown the film on home visits.

Some have quit smoking and talk openly about the dangers. Healthcare professionals are giving consistent and informative safety messages. The film is also valuable to patients who cannot speak English, read or write. It continues to be evaluated through patient comment cards.

Serious untoward incidents will continue to be monitored over a five-year period through our oxygen contractor’s data. Our recent figures on serious untoward incidents show a fall of 40%.

We wanted to enable others to access it so it is freely available on Youtube. It is currently being used as an educational tool by fire services and home oxygen services nationally. 

Its success is the result of teamwork and mutual aims to improve health, safety and wellbeing of vulnerable patients at risk of serious injury if they smoke and are on oxygen therapy.

It was delivered with the patient as the central focus and heart of the service and that is reflected in its impact.
 

Julie Danby is a respiratory nurse specialist at City Health Care Partnership Hull. She was a finalist in the LV Liverpool Victoria-sponsored Innovations in your Specialty category of the RCNi Nurse Awards 2016.

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