Primary Care Oxygen Assessment and Management of the Oxygen Service'

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Primary Care Oxygen Assessment and Management of
the Oxygen Service.

• Judith McElroy RGN BSc(Hons)
• Respiratory Service Manager
• East Lancs PCT
• Laura Hugall MRPhams
• Primary Care Pharmacist
• East Lancs PCT.
• Karen Hatch.
• Development Improvement Manager Medicines
  Service. Cumbria Lancs StHA.

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StHA

• View that Medicines Management Team took to
  implement the Home Oxygen Service across Cumbria
  and Lancashire StHA.

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In The Beginning within the PCT

• Good team work, between Medicines Management and
  Service Provision.
• Strategic lead
• Managed the team and led the assessment process.
• Prior to Feb 06 we looked at the possible
  problems and considered how we would overcome
  them.

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Strategic

• PCT Level flagged as a risk.
• General Practice asked not to prescribe and
  the monitoring of this continues.
• Community Pharmacy regular communication.
  Considering a LES.
• OOH worked proactively to reduce need for their
  involvement.

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Staff Training

• All staff within the Pulmonary Rehabilitation and
  Oxygen service are trained in Spirometry (ARTP),
  completed or willing to undertake the COPD
  module, have 3 years experience and 12 months
  Primary Care experience.
• Ongoing training is a priority within the
  service.
• Within the PCT, we had done a large piece of work
  around COPD and training needs.

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Staff Training Cont

• Community Pharmacists, within their CPPE
  workshops.
• Community Matrons, within their induction
  programme.
• Education to HCP, what to do if they think a
  patient needs O2.

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Management and Assessments

• We now manage three PCTs for Oxygen across East
  Lancs.
• Communication with GPS, Patients, and Health
  Care professionals, Secondary Care and OOH
• As a service we see all the patients on SBOT and
  AOT.
• Secondary Care continue to assess and monitor
  LTOT.

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Management and Assessments cont

• All HCPS are asked to not complete HOOFS unless
  it is an emergency and after 4pm, then a copy is
  faxed to our service, so that we can send through
  the cancellation HOOF.
• All other times if a patient needs an assessment,
  details faxed to the service, the patient is
  contacted and seen within 24-48 hours.

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What is monitored in the service

• Registers.
• HOOFs/ emergency (CC1)
• Invoices.
• Patients.
• Correspondence to GPs and Consultants.
• Patient Deaths

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Assessments

• Patients assessed in Clinic settings and within
  their own homes.
• Full holistic assessments,
• Spirometry test if required.
• 6MWT or MET analysis.
• All Patients have Oxygen grades completed.
• All information passed to GPs for QOF data.
• All Patients Followed up at 2/6/12 months and
  then (every) 6 monthly.

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Why

• Holistic care.
• Right O2 at the right time.
• Equipment dependant on Clinical needs.
• Inappropriate or over prescribing for O2 therapy.
• Patient satisfaction.
• Appropriate follow ups.
• Reduced hospital admissions/GP visits.
• Timely early discharges
• Cost effectiveness.

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Patient Education

• Extremely important part of the assessment.
• What is O2?
• Why have they been Prescribed O2?
• How and when to use the O2.
• Patient Safety when using O2.
• Breathing exercises.
• Pulmonary Rehabilitation.
• Inhaler devices/drugs/compliance.
• Disease area Knowledge.

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Patient Safety

• Once O2 safety is discussed with the patient,
  they sign to say we have gone through the
  leaflet, and this gives consent for the
  Lancashire Fire and Rescue service to contact the
  patient.
• MoU, set up with the Fire Service and the PCT, to
  complete home safety checks in all homes with O2
  in, plus the houses on either side of the
  patients home.
• Fire safety check includes fire alarms fitted and
  advise on where to and how to store O2 on the
  home.
• All information gathered by the fire service is
  transferred onto the Fire Service computer.

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Thank you and Any Questions?