Q&A 335.3
Do oxygen cylinders need to be prescribed on an individual patient basis in residential nursing homes?
Prepared by UK Medicines Information (UKMi) pharmacists for NHS healthcare professionals
Before using this Q&A, read the disclaimer at www.ukmi.nhs.uk/activities/medicinesQAs/default.asp
Date prepared: 25th February 2015
Background
There are times when a clinician considers it appropriate to prescribe oxygen to a resident of a nursing home. If the oxygen is required urgently, the delay in obtaining the supply via the current systems may be inappropriately long. This Q&A addresses the practicalities of obtaining oxygen in the residential nursing home setting in an emergency.
Answer
Oxygen is classified as a general sales list medicine. (1) As such, it may be purchased without a prescription. Oxygen may also be supplied on the NHS for domiciliary (home) use by specific patients, upon the completion of an NHS Home Oxygen Order Form (HOOF) by the prescriber. (2)
Oxygen is prescribed in primary and secondary care to relieve hypoxia in wide range of conditions. (3-5) In the care home setting, GPs may arrange for a formal oxygen assessment. Breathlessness is not the same as hypoxia so it is important that patients are assessed. There is no evidence to suggest that oxygen therapy is any more effective than moving air on the face, such as an open window or fan, for breathlessness. (4-6) Oxygen should therefore only be used if a patient is hypoxic.
Dependent on the assessment of the patient, a HOOF part A (before oxygen assessment – non-specialist or temporary order) or part B (after specialist / paediatric assessment), will be completed. (2) The level and frequency of oxygen will be documented on the HOOF as well as the reason for needing oxygen. The HOOF does not allow oxygen cylinders to be ordered for general use or as spares. Following a request for oxygen via a HOOF, a contractor will deliver the oxygen the next day for hospital discharge or clinical assessment services, within 3 working days for a standard order or within 4 hours for an urgent response. (2) An urgent response carries a price premium. (5)
There are currently four companies in England and Wales contracted to provide Home Oxygen Services for the NHS, each covering a specific geographical area. (7) Only one of these suppliers will also supply oxygen privately to care homes. (8-11)
BOC (8) – do not sell or rent oxygen cylinders to care homes.
Air Liquide (9) – do not sell or rent oxygen cylinders to care homes.
Baywater Healthcare (10) - do rent oxygen cylinders to care homes for use in an emergency. Telephone: 0800 373580
Dolby Vivisol (11) – do not sell or rent oxygen cylinders to care homes.
Summary
To supply oxygen to a patient in a residential care home, with or without nursing, on the NHS, a patient specific order must be made using the appropriate HOOF for each individual patient. If, however, a residential care home wishes to keep a ‘spare’ oxygen cylinder, for use in an emergency, or for palliative care, it may purchase, or rent, a cylinder directly from one of the oxygen supply companies. This would be a private, i.e. non NHS funded, arrangement between the oxygen supplier and the care home.
Limitations
The suitability of supplying emergency short-term oxygen to residential care homes with or without nursing, has not been considered. The urgent need for oxygen supply would need to be assessed by medically trained staff. The availability of a spare oxygen cylinder should only be to reduce the delay in supplying oxygen in an emergency. Other companies may sell or rent oxygen cylinders privately. Only the suppliers of oxygen with an NHS contract have been contacted.
References
1. Medicines Ethics and Practice: The Professional Guide for Pharmacists. Edition 38, July 2014. Royal Pharmaceutical Society of Great Britain. Accessed on 18/02/2015
2. NHS Home Oxygen Order Form (HOOF) part A. Accessed on 18/02/2015 via
www.pcc-cic.org.uk/article/home-oxygen-order-form
3. Brayfield A, editor. Martindale: The Complete Drug Reference. Oxygen monograph, date of revision of the text 26/09/2013. Accessed on 18/02/215 via http://www.medicinescomplete.com/
4. British Thoracic Society. Emergency Oxygen Guideline Group. Guideline for emergency oxygen use in adult patients: Thorax 2008; 63 (suppl VI): 1-73. Accessed on 25/02/215 via www.brit-thoracic.org.uk/document-library/clinical-information/oxygen/emergency-oxygen-use-in-adult-patients-guideline/emergency-oxygen-use-in-adult-patients-guideline/
5. Pearce L. Routine use of oxygen in primary care. Primary Care Respiratory Society UK – Opinion No. 44 March 2011 (revised November 2011) Accessed on 25/02/2015 via www.pcrs-uk.org
6. Abernethy AP, McDonald CF, Frith PA et al. Effect of palliative oxygen versus room air in relief of breathlessness in patients with refractory dyspnoea: a double-blind, randomised controlled trial. The Lancet 2010;376(9743):784-79.
7. Home oxygen treatment. Accessed on 18/02/2015 via www.nhs.uk/conditions/home-oxygen/Pages/Introduction.aspx
8. Personal communication with BOC on 18/02/2015.
9. Personal communication with Air Liquide on 18/02/2015.
10. Personal communication with Baywater Healthcare on 18/02/2015.
11. Personal communication with Dolby Vivisol on 18/02/2015.
Quality Assurance
Prepared by
Sarah Cavanagh, East Anglia Medicines Information Service
Date Prepared
25 February 2015
Checked by
Katie Smith, Director, East Anglia Medicines Information Service
Date of check
27 February 2015
Search strategy
Embase; search term: home oxygen therapy, limit to: Human and English Language and Publication Year 2013-Current.
In-house database, MI Databank, search term ‘home oxygen’
Internet Search, Google: search term: Home Oxygen.
Personal communication with BOC, Air Liquide, Baywater Healthcare and Dolby Vivisol.
2
Available through NICE Evidence Search at www.evidence.nhs.uk