Audit of oxygen administration to achieve a target oxygen saturation range in acutely unwell medical patients.

Abstract

To evaluate documentation of a target oxygen saturation (SpO₂) range and ability to achieve this range in acutely unwell inpatients. In this single-centre audit, patients with discharge diagnoses of pneumonia, heart failure and exacerbation of asthma or COPD admitted to Wellington Regional Hospital, New Zealand between 1 June 2019 and 31 August 2019 who received oxygen were identified. In those with a documented target SpO₂ range, the proportion of SpO₂ measurements in the observation chart which were within, above and below range were determined as well as the maximum and minimum SpO₂. Regression analysis was performed to determine whether these outcomes were influenced by the prescribed range, high-dependency care or the number of adjustments to oxygen administration. 268 admissions were screened. Of the 100 eligible admissions who received oxygen, a target SpO₂ range was documented in 62. The mean (SD) proportion of SpO₂ measurements within range was 56.2 (30.6)%. A hypercapnic target SpO₂ range was associated with a higher probability of an SpO₂ above range; multivariate OR 5.34 (95% CI 1.65 to 17.3, p=0.006) and a lower probability of an SpO₂ below range; multivariate OR 0.25 (95% CI 0.08 to 0.80) p=0.02. The mean (SD) maximum SpO₂ was similar in those with a target range of 92%-96% versus a hypercapnic range; 96.2 (3.0)% and 95.2 (3.4)%, respectively. Oxygen prescription and delivery in this clinical setting was suboptimal. SpO₂ values above the designated range are common, particularly in patients with a hypercapnic target range.