The Science Journal of the American Association for Respiratory Care

2012 OPEN FORUM Abstracts


Michael Bocci, Ken Hargett, Jose Rodriguez, Margaret Berger, Christie Farrar; Respiratory Care Services, The Methodist Hospital, Houston, TX

Introduction: Physician orders are mandatory for a patient to receive oxygen. A valid order includes the delivery device, liter flow, frequency and special instructions such as desired saturation. In 2011 one area our institution experienced an increase in patients without a valid Physician order. Hypothesis: Interdisciplinary education and training can reduce the incidence of patients receiving oxygen without valid orders. Methods: A quality and education project was developed utilizing Performance Improvement methodology. An analysis was completed that indicated several reasons for the lack of valid orders. Interviews with nursing uncovered an “urban myth” that patients on low level oxygen for shortness of breath or chest pain did not require orders. Additionally patients admitted from the Emergency Department and direct admits from physician’s offices had a high incidence of no orders. An education program was developed that included meetings with multiple physician groups, multiple nursing meetings, creation of signage, and revision of the order location in the CPOE (computerized physician order entry) order set. A daily audit process was introduced with monitoring of all patients on the affected unit. An immediate follow-up with physicians identified by the audits was initiated. Audit results also indicated the placement of the oxygen order in the admission order set was problematic. An update and relocation of the oxygen order in the CPOE admission order set was completed. Results: Initial baseline audits for quarter 3 of 2011 indicated 114/1667 (6.84%) patients did not have required orders. 4th quarter 2011 showed improvement with 59/1639 (3.6%) without orders. Through continued implementation and follow-up the 1st quarter 2012 showed a decrease to less than 1%. Discussion: Multiple issues were identified as barriers to completion of the required oxygen order. A systematic quality improvement process with daily audits has reduced the incidence of oxygen being administered without a valid order at our institution. A multidisciplinary approach in a large tertiary hospital can be utilized to identify barriers and change practices to achieve desired outcomes. We have expanded this program to the entire campus. Sponsored Research - None