The Science Journal of the American Association for Respiratory Care

2005 OPEN FORUM Abstracts

EVALUATION OF AN OXYGEN PROTOCOL IN LONG TERM CARE

Sherrie Christman, CRT, Teresa A. Volsko, MHHS, RRT, FAARC, Advanced Health Systems, Hudson, Ohio

The benefits of respiratory care protocols have been well established in the acute care setting. However, documentation of the use of protocols in the long term care setting is lacking. The purpose of this study is to determine the effect of protocol-directed recommendations for oxygen therapy implemented by respiratory therapists in skilled nursing facilities. Researchers hypothesize that the use of protocol-directed recommendations for oxygen therapy will reduce the number of missing, or incomplete orders and oxygen use in skilled nursing facilities.

METHODS:
A convenience sample of 281 residents requiring oxygen therapy in 17 Ohio-based skilled nursing facilities was conducted. Respiratory therapists employed by the facility's contracted respiratory service provider evaluated the resident's need for oxygen therapy and recommended changes to the plan of care according to an oxygen protocol. Recommendations for oxygen order changes were based on a sign and symptom, algorithm-based care plan. Recommendations made to clarify incomplete or obtain an order for residents receiving oxygen therapy were based on guidelines established by the Ohio Department of Health. Data were prospectively collected from January 1, 2005 - March 31, 2005. Appropriateness and completion of oxygen therapy orders were assessed. Resident demographics, recommendations for care plan changes and acceptance or decline of protocol-directed recommendations were tracked. Data were analyzed by SPSS 10.0 for windows (SPSS, Inc., Chicago, IL, 1999).

RESULTS:
A total of 346 resident evaluations were performed. 73% of the sample population was male. The mean age was 83 years (SD ± 11.8), range 30 - 102 years. Payor mix included Medicaid (45.9%), Medicare Part A (35.9%), Private Pay (11%) and Hospice (7.1%). Recommendations for care are summarized in the table below.

Type of Recommendation Recommendation Outcome
Made Accepted
n %n %
No change to current plan indicated 193 55.8 n/a n/a
Obtain an order for oxygen currently in use 5 1.4 5 100.0
Discontinue oxygen therapy 71 20.5 66 93.0
Wean oxygen flow rate or FIO2 12 3.5 8 66.7
Clarify the incomplete oxygen therapy order 41 11.8 35 85.4
Change from continuous oxygen use to PRN 11 3.2 7 63.6
Initiate oxygen therapy 13 3.8 12 92.3

Discontinuation of oxygen therapy resulted in a cumulative savings of 1,175 billed days to participating skilled nursing facilities.

CONCLUSIONS:
Successful implementation of oxygen protocol-directed recommendations can reduce the cost of care, and improve compliance with mandatory and voluntary accreditation agencies by reducing the number of missing and/or incomplete orders for oxygen therapy.

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