Supplemental Oxygen Prescription Practices

Supplemental Oxygen Prescription Practices

1. What is the decision or change you are facing or struggling with where a summary of the evidence would be helpful?

We need a comprehensive review of current home supplemental oxygen prescriptions. Current prescribing practices have been virtually unchanged for approximately 100yrs. Since then, medical and technological advances have render traditional prescribing obsolete. Prescribed by device output such as liters per minute Two major changes have occurred in the last century that are not well understood by prescribing physicians. The need to keep patients with chronic lung diseases active and mobile decreases deconditioning and slows progress of their disease. The new portable oxygen systems are not designed with outputs calibrated in liters per minute. Outputs vary from device to device, depending on a host of factors including whether the device is pulse dose or continuous flow, gaseous, or oxygen concentrator, and rustiness of the devices. The result of these technological advances leads to only one way to assure adequate prescribed oxygenation targets are achieved and maintained, at rest and while active; is to prescribe a target range of oxygen saturation. It is interesting to note that virtually all patients on supplemental oxygen is hospitals have this parameter monitored through their stay. This is now practical due to availability of inexpensive pulse oximeters. They cost a little as $25. Patients can then titrate oxygen outputs based on this measurement while e active and at rest. The concept is the same as used for diabetics to monitor blood sugar.

2. Why are you struggling with this issue?

Current practice uses prescription based on liters per minute outputs. Even though many of the portable devices used are technically incapable of such outputs. Most physicians are unaware of this limitation or the nuances associated with 21st century portable oxygen systems. Add in the fact that CMS has statutory requirement calling for oxygen prescriptions to include liters per minute as part of its payment formula These conditions combine to perpetuate obsolete prescription practice for supplemental oxygen.

3. What do you want to see changed? How will you know that your issue is improving or has been addressed?

Change the prescription for supplemental oxygen from liters per minute to targeted saturation ranges to be titrated by patients as they vary activity. Not unlike what diabetic patients have done successfully for years. Provide guidance to oxygen device selection for prescribers based on their ability to adequately oxygenate. Leverage scientific evidence regarding the benefits of keeping those with chronic lung diseases active thus improving their health status and lowering exacerbations. This approach can also tell us when oxygen is no longer needed but he patient and decrease unnecessary utilization.

4. When do you need the evidence report?

Tuesday, February 2, 2021

5. What will you do with the evidence report?

The Coalition would promulgate its results and organize free education and training to make all stakeholders aware of the change and its importance in improvement of management of patients with chronic lung diseases by encouraging activity while assuring adequate oxygenation.

Supporting Document

Respiratory Care (PDF)

Title or short description: This paper provides a comprehensive overview of the issue including clinical and technical

Comments or notes about this file: This paper is accurate in describes the variations of devices commonly used, as well as practice related challenges. Newer devices have come on the market since publication, but the operating principle have not changed. You may find the reference so some assistance.

(Optional) About You

What is your role or perspective? Retired registered respiratory therapist/ volunteer patient advocate

If you are you making a suggestion on behalf of an organization, please state the name of the organization: US COPD Coalition

May we contact you if we have questions about your nomination? Yes

Page last reviewed December 2020
Page originally created July 2020

Internet Citation: Supplemental Oxygen Prescription Practices. Content last reviewed December 2020. Effective Health Care Program, Agency for Healthcare Research and Quality, Rockville, MD.

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