1995 OPEN FORUM Abstracts
A CLINICAL TRIAL OF COMPUTERIZED OXYGEN THERAPY PROTOCOL FOR NON-ICU PATIENTS
Sandy M. Metcalf. R.R.T., Xiaoping Zhang, M.D., C. Jane Wallace, R.N., M.S., A. Tupper Kinder, B.S., Loren Greenway, R.R.T., and Alan H. Morris, M.D. Pulmonary Division/Respiratory Care, LDS Hospital, 8th Avenue and C Street, Salt Lake City, UT 84143
In order to deliver standardized care at the bedside and improve the quality of oxygen therapy, we developed a computerized oxygen therapy protocol (COTP) for non-ICU patients, and integrated it into the LDS Hospital's HELP computer system. We defined excessive use of oxygen (Excessive) as SpO_2 >=94% with oxygen therapy, reasonable use or reasonable non-use of oxygen (Reasonable) as SpO_2 between 90% and 93% with, or SpO_2>=90% without oxygen therapy; and insufficient use of oxygen (Insufficient) as SpO_2 < =89% with or without oxygen therapy. The basic COTP logic is: increase oxygen therapy whenever Insufficient, decrease whenever Excessive, and maintain current oxygen therapy, if any, for at least 12 hours before a further decrease in therapy, if the SpO_2 is 90-93%. Oxygen therapy data from 1/1/94 to 3/31/94 (339 patients) before the use of COTP in one medical and one surgical ward of our hospital was used as a historical control. Thereafter, COTP was put into routine use in the same wards from 11/1/94 to 3/31/95 (706 patients). The results are shown in Table 1 and 2.
Table 1. Oxygen Therapy Classification Before (1/94-3/94) & After (11/94-3/95) the Use of COTP
Measurements Duration in Hours Mean±SEM Interval*
BeforeAfter PBeforeAfter PBeforeAfter P
Excessive 2128(33%) 4333(40%)< 0.01 10349(31%) 21653(31%) 1 4.9±0.1 4.5±0.1< 0.01
Reasonable 3444(54%) 5501(50%)< 0.01 20775(62%) 45970(66%)< 0.01 6.0±0.1 8.4±0.2< 0.001
Insufficient 790(12%)1023(9%) < 0.05 2404(7%) 2568(4%) < 0.01 3.0±0.2 2.5±0.1< 0.01
Total 6,323 10,857 33,52870,191
*Interval in hours between 2 consecutive SpO2 measurements.
Table 2. Hypoxemia(SpO2 < =87% for>3 Min) Before(1/94-3/94) & After(11/94-3/95) the Use of COTP
Hypoxemia Incidence5.7%(349/6323)4.3%(470/10857)< 0.001
Mean±SEM Hypoxemia Index (%hours)* 17.2±29.614.4±24.50.145
O2 Therapy Change Following hypoxemia
O2 Therapy Increase55%(167/304*) 73%(306/421*)< 0.01
No O2 Therapy Changes 40%(122/304)25%(104/421) < 0.01
O2 Therapy decrease5%(15/304) 3%(11/421)< 0.05
* Hypoxemia Index is defined as [(90% - SpO2) x Time_on_that_SpO2]
* Excluded those unable to evaluate because of missing data, and those already receiving maximum O2 Therapy.
Table 1 indicates that COTP has been followed by a reduction of the incidence, duration, and mean interval of insufficient use of oxygen but not by a reduction in duration of excessive use of oxygen. Table 2 indicates that COTP has been followed by an increase in appropriate response to hypoxemia (oxygen therapy increase) and a decrease in inappropriate response (oxygen therapy decrease or no change). These data suggest that our COTP for non-ICU patients is favorable.