HNY Policy and Pathway Repository - Humber

The CHCP CIC Home Oxygen service is available for adults 18 and over who are registered with a Hull or East Riding of Yorkshire GP.  The service provides a quality home oxygen assessment service that addresses both the clinical and financial risks of domiciliary oxygen prescribed in both the community and secondary care.  The team offers a multidisciplinary approach with medical support from a Respiratory Physician for those patients with complex respiratory requirements, through access to the COPD MDT weekly meetings.  The team are responsible for the assessment, administration and review of home oxygen, which include long term oxygen therapy, ambulatory oxygen, palliative oxygen and withdrawal of oxygen when no longer required.  For those patients with a non-respiratory diagnosis the Respiratory Nurse Specialist shall work in collaboration with Consultants and other Nurse Specialists who are responsible for the care and management plan of the patient’s condition.  Oxygen for these patients will be administered through a shared care approach with primary responsibility lying with the Prescriber, which may be primary or secondary care based.

Evidence of hypoxia <90% on pulse oximetry at rest or during activity.

Acutely unwell patients should not be referred to the Home Oxygen Service for oxygen assessment until all treatments have been optimised and stability achieved.

Acutely ill patients must be referred to the acute service.

Frequent exacerbators may be referred if they cannot achieve stability over the required 5-8 weeks (Proof of this must be seen on the referral form) and also discussed with the Home Oxygen Team.

Exclude Red Flag Symptoms

Severe hypoxia during an acute episode requires immediate attention via the acute service.

Do Not Refer

Acutely ill patients until 8 weeks post infection / exacerbation.

Patients that are not desaturating should not be referred for ambulatory oxygen assessment.

Clinical judgement re frequent exacerbations: to discuss with service – may consider assessment earlier at 5 weeks post infection / exacerbation.

Patients requiring oxygen for cluster headaches.  This is prescribed by the Neurological Specialist team in accordance with latest neurological guidelines.

Palliative Care oxygen orders may be processed by GP’s Macmillan Nurses and guidance on how this should be done can be provided by the Home Oxygen team.  Patients with cancer or end stage respiratory disease who are experiencing intractable breathlessness should not receive treatment with palliative oxygen therapy (POT) if they are non-hypoxemic with oxygen saturation levels ≥92%. Alternative management

• Adopt breathlessness management techniques
• Trial of handheld fan therapy
• Calming hand / breathing square
• Trial of pharmacological treatment
• Consider referral to physiotherapy and occupational therapist for assessment for aids and adaptations to the home

If unresponsive to the above alternative strategies patients should be referred for specialist assessment and the case should be discussed with the Home Oxygen Service.  Where palliative oxygen therapy is required in last few hours of life the GP can process an oxygen order through completion of HOOF A prescription.

The patient should be under the care of a Hull or East Riding GP.

Long term Oxygen Therapy Assessments LTOT – Patients should have a confirmed medical diagnosis causing hypoxia and be optimised on appropriate disease specific treatment, at referral there will be documented evidence of oxygen saturations (SpO2) of below 92% or evidence by spirometry of severe lung disease (FEV1), or secondary complications such as polycythaemia.

Ambulatory Oxygen Therapy Assessment – Patients should have a confirmed medical diagnosis causing hypoxia on exertion defined as a drop in SpO2 ≥4% resulting in being <90% and be optimised on appropriate treatment and are able to achieve a period of stability for 8 weeks. Patients who exacerbate more frequently may need to be assessed at an earlier stage.  This requires discussion with the Home Oxygen Team. 

Referrals

Email referral form to CHCP.247111@nhs.net

Referrals triaged as urgent will be seen within 2 working days

All referrals classed as routine will be seen within 10 working days

The patient requires a confirmed diagnosis of hypoxia, treatments optimised and also free from exacerbations (between 5-8 weeks clear).  For patients that frequently exacerbate referrer to discuss with the Home Oxygen Service Clinician.

Information to Include 

Medical history and confirmed diagnosis

Current medications

Pulse oximetry results

Spirometry results

Period of stability of at least 8 weeks, 5-8 if frequent exacerbations

Smoking status:  Number of cigarettes smoked

Has smoking cessation been offered

Safety issues / risk factors

Existing oxygen user: Latest prescription

Accessible information needs