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Home oxygen is prescribed for patients who have low levels of oxygen in the blood (hypoxia) which is a symptom of many lung conditions, some heart conditions and occasionally other more rare conditions. The oxygen helps protect vital organs (for example, the heart, the kidneys, the brain, etc.) from the effects of long term low oxygen levels.
Oxygen is a drug and patients must have a throrough assessment by an oxygen specialist before it is prescribed. This is to ensure that only patients who will benefit from oxygen receive it and the correct dose of oxygen and equipment is ordered for the patient.
Unfortunately, home oxygen is a poor reliever of breathlessness so is not recommended for this symptom, unless oxygen levels are low. However, there are other ways the team may be able to help, for example, adjusting your inhaled therapy or referring the patient for Pulmonary Rehabilitation.
Long term oxygen therapy (LTOT) is prescribed for patients who have consistently low levels of oxygen in the blood. It is usually administered through a machine called an oxygen concentrator and must be used for a minimum of 15 hours per day (which includes the hours of sleep) to be of benefit.
Ambulatory oxygen therapy (AOT) is portable oxygen that some patients need on exertion outside of the home. Only patients with low levels of oxygen on exertion will benefit from this treatment. Some patients need this as well as LTOT but others may only need it if they are active outside of the home.
There are several options for this type of oxygen although not all equipment is suitable for every patient. The most common are small cylinders that weigh between 5-8lbs and can be carried over the shoulder or wheeled in a trolley.
Other options include liquid oxygen (LOX), portable concentrators (POC) and transportable concentrators (TOC). Each patient will be individually assessed and given the equipment that suits their needs.
All oxygen assessments are performed by specialist nurses and usually last about an hour. The ideal place for the assessment is in one of our clinics as the equipment needed for the assessment and for demonstration to the patient is available there. Clinics are currently held in Albert Lodge (Victoria Central Hospital, Wallasey), Arrowe Park Hospital or Civic Medical Centre (Bebington), but, if a patient is housebound, arrangements can be made for them to be assessed at their home.
During the assessment, there will be time spent discussing the patient's history, current medications and symptoms before checking blood pressure, pulse and oxygen saturations.
It may be necessary to take an Arterial Blood Gas test (ABG) to accurately check levels of oxygen and carbon dioxide in the blood. The specialist nurses have plenty of experience in taking this blood sample and are able to analyse it and give the result in a few minutes.
If the results show that oxygen is recommended, the nurse will discuss this in detail and a decision will be made with the patient on what the treatment will be.
If the assessment is for AOT, a walk test will be performed to examine oxygen levels during exertion. A second walk test using oxygen may be needed depending on the results of the first test.
The patient will be kept fully informed and given time to discuss any concerns or worries at all stages of the assessment process, including test results, the treatment plan and whether or not oxygen is recommended.
After the assessment, the GP and anyone else involved in the patient's care will be informed by letter of the results and the plan.
A patient's quality of life is very important to us so we strive to see a patient within four weeks of receiving the referral for a routine assessment. If the patient has been referred to us as a matter of urgency, we have the capacity to see them sooner than this.
If the patient develops a chest infection prior to the appointment, then the service needs to be contacted to rearrange the appointment as this will effect the test results.
Air Liquide are the company who supply oxygen for the Wirral patient's once it has been prescribed. The oxygen nurse will send the prescription to Air Liquide who will then process it. The patient will be contacted by a member of the customer service team to arrange delivery of the oxygen equipment.
Air Liquide will then offer assistance with:
- Refills of cylinders
- Technical problems with equipment
- Holiday orders (unless the patient requires a change to the usual treatment then they will be urged to contact their oxygen service)
As the NHS is sharing information about the patient with an outside company, we will ask the patient for their consent. Information shared will only be used in conjunction with supplying oxygen.
All adults (with just one or two exceptions) who have been assessed and prescribed oxygen will remain under the care of this team for oxygen review. This will mean regular assessments to ensure the oxygen is still needed or to make any alterations if anything changes.
The team will also carry out risk assessments and discuss health and safety issues.
If there are other people involved in your care such as community matrons, district nurses or other carers, we will keep in touch with them so that they can contact us if there are any problems between our visits.
Patient's and their families can also contact us with any concerns or if they think changes may be needed.
Oxygen therapy is safe if used correctly. Just remember that oxygen therapy enriches the air around the equipment, so please:
- Do not smoke while using oxygen - if the patient must smoke then they must turn off their oxygen concentrator/cylinder, move away from the area where the oxygen therapy was being used and leave 30 minutes before they light the cigarette (oxygen stays on the clothes and can make them more flammable)
- Do not use oxygen around naked flames such as gas fires, cookers and candles
- Please be aware that e-cigarettes are a fire risk so do not use or recharge them around oxygen and follow the same advice as mentioned above with smoking
- Please let the oxygen nurse know if the patient has an air-flow mattress
- Please let the oxygen nurse know if the patient does not have working fire alarms in their property
Please be aware that the patient may be contacted by the Merseyside Fire Service.
Oxygen is a drug and can cause serious problems when not used properly. It must never be used by anyone it is not prescribed for. Please remember:
- Never alter the flow rate on the concentrator/cylinder unless told to do so by an oxygen nurse
- Do not use portable cylinders in the home. The patient is being treated for low oxygen saturation levels while exerting themselves - it may cause them harm if they use oxygen at rest. If the patient feels there is a need for oxygen inside the home, please contact the service
- Do not use oxygen for longer than prescribed unless advised to do so by an oxygen nurse