Home Oxygen Review, Adult Service (HOS-R)

IslingtonHaringey
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Home oxygen therapy is used for the treatment of chronic hypoxia. It is most commonly prescribed for the management of severe chronic obstructive pulmonary disease (COPD). It may also be considered and prescribed for other respiratory diseases causing chronic hypoxia, once all reversible causes have been identified and treated. These include interstitial lung disease (‘pulmonary fibrosis’) including following Covid-19 pneumonitis, morbid obesity causing nocturnal hypoventilation/obstructive sleep apnoea, and other rarer chronic respiratory diseases. It is occasionally also prescribed for cardiac (chronic heart failure) and other causes of chronic hypoxia. 

Other prescriptions for oxygen to be used at home include:

  • for neonates and children with chronic hypoxia under the care of paediatric or neonatal teams
  • for patients with chronic-worsening hypoxia with progressive diseases including cancer approaching the end of life under the care of the palliative care team
  • high flow short burst oxygen therapy may also be prescribed by neurologists for cluster headaches; this is the only indication for oxygen to be prescribed without co-existing hypoxia.

Service principles

  • Oxygen should be prescribed and managed as a drug/treatment for hypoxia not breathlessness.
  • Oxygen should only be prescribed by clinicians with training and competencies in oxygen prescribing and use.
  • All home oxygen prescribing and use should be evidence-based and high value treatment.
  • Many respiratory patients on home oxygen have complex health needs and a high risk of death so benefit from an integrated care approach.

Islington HOS-R Service

The multi-disciplinary Islington HOS-R team consists of a specialist respiratory physiotherapist and respiratory specialist pharmacist, with support from a respiratory consultant physician.

The aims of the Islington HOS-R team are to:

  • optimise benefit from oxygen therapy
  • reduce harm from trips, falls, smoking, fire and oxygen toxicity
  • maximise value from oxygen equipment use
  • improve patient and carer experience of having and using home oxygen.

The Islington HOS-R team reviews:

  • all patients with a new home oxygen prescription within four weeks
  • all patients with respiratory disease at least once a year.

Haringey HOS-R Service

The Haringey multi-disciplinary HOS-R team consists of a respiratory consultant physician, a specialist respiratory pharmacist, and a specialist respiratory nurse or respiratory physiotherapist.

The aims of the Haringey HOS-R team are to:

  • optimise benefit from oxygen therapy
  • reduce harm from trips, falls, smoking, fire and oxygen toxicity
  • maximise value from oxygen equipment use
  • improve patient and carer experience of having and using home oxygen.

The Haringey HOS-R team remit is to review:

  • all adult patients with a new home oxygen prescription from AirLiquide within four weeks
  • all adult patients with a home oxygen prescription for respiratory diseases at least once a year
  • all adult patients with a home oxygen prescription whose hypoxia is cause by non-respiratory conditions at least once a year (i.e. not including cluster headaches)
  • all adult patients with a home oxygen prescription started as part of approaching the end-of-life care under the care of the palliative care team, who continue with home oxygen, after four months.

These patients are also seen by the Haringey HOS-R team for review at four months if still appropriate:

  • reviews for patients prescribed oxygen for cluster headaches by neurologists (queries for this patient group should be addressed to their neurologist).

Eligibility criteria

Inclusions

Islington HOS-R Service

  • any adult patient registered with an Islington GP who has been prescribed home oxygen

Haringey HOS-R Service

  • adult patients registered with a Haringey GP who have been prescribed home oxygen
  • please note: it is the GP address, not the patient address, that determines which HOS-R team takes on reviewing a patient.

Exclusions

Islington HOS-R Service

The service does not provide:

  • oxygen assessments for new prescriptions
    • referrals for assessment for a new oxygen prescription should be made as a referral to the respiratory clinic as this needs to include review of diagnosis and reason for deterioration and optimisation of treatment before new prescription of home oxygen
    • if new, acute deterioration should be referred for admission for management of new respiratory failure.
  • reviews for patients prescribed oxygen for hypoxia under the care of the palliative care team with:
    • cancer with hypoxia
    • advanced progressive multi-morbidity with hypoxia.
  • reviews for patients prescribed oxygen for cluster headaches by neurologists
    • queries for this patient group should be addressed to their neurologist.

Haringey HOS-R Service

Home oxygen therapy is only one component of the management of patients with severe and/or complex respiratory disease who also need to continue under the care of a respiratory team. In particular, this patient group is often also living with disabling and/or frightening breathlessness.

Hence, the HOS-R service does not provide:

  • oxygen assessments for new prescriptions:
    • Referrals for assessment for a new oxygen prescription should be made as a referral to a respiratory clinician/respiratory service. Before a new prescription for home oxygen, patients need a specialist respiratory assessment in order to:
      • review diagnosis and reason for deterioration
      • optimise treatment that might reverse hypoxia
      • review impact, understanding and management of breathlessness
      • start advance care planning conversations
      • agree plan for continued respiratory input into care.
    • for new oxygen needs – which usually reflect a change in disease course (e.g. change in ambulatory oxygen needs) – referrals for assessment should be made back to the respiratory team looking after the patient’s underlying condition
    • for acute deterioration (worsening hypoxia), patient should be referred for urgent respiratory review/admission for diagnosis and management of new respiratory failure.
  • initial reviews for patients prescribed oxygen for hypoxia under the care of the palliative care team with:
    • cancer with hypoxia
    • advanced progressive multi-morbidity with hypoxia.

How to refer

The following clinicians can refer to this service: GPs

EMIS form

Referral methods: Email

Islington HOS-R Service

Complete the form on EMIS and send via email to whh-tr.islingtonhos@nhs.net

Haringey HOS-R Service

For patients with respiratory diseases (e.g. COPD), developing borderline hypoxia, referrals should be made to a hospital respiratory team for a full respiratory review, including assessment for home oxygen.

If patients are using home oxygen from any other source than AirLiquide, the referral should be made to a hospital respiratory team for initial assessment.

The Haringey HOS-R team have a system in place that identifies all new AirLiquide prescriptions for home oxygen for patients under the care of a Haringey GP, which patients need to be reviewed, and the appropriate time. 

It would therefore be unusual for a Haringey GP to need to refer to the HOS-R team.

However, if you do have any queries regarding patients on home oxygen, please contact the Haringey HOS-R team via whh-tr.haringeyhos@nhs.net This inbox is monitored regularly and you should receive a response within 48 hours.


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