Managing oxygen in care homes

Oxygen is a medical gas. You should treat it as a medicine.

Some people living in care homes use oxygen. It involves breathing air that contains more oxygen than normal air from a cylinder or machine. It may be prescribed for people who have a condition that causes low oxygen levels in the blood.

Oxygen therapy

Long term oxygen therapy (LTOT or home oxygen) can be given via a:

• tube positioned under the nose (nasal cannula)
• face mask placed over the nose and mouth
• mask attached to an opening in the throat (tracheostomy)

Oxygen must only be prescribed by a specialist after a clinical review. This would usually be a respiratory health care professional.

For any person who is prescribed home oxygen, you should know:

• the named prescriber
• the clinical reason for the oxygen
• the recommended flow rate
• how the oxygen should be used by the person it has been prescribed for.

You must record the following information in the person’s oxygen care plan and medicines administration record:

• the normal oxygen saturations for the person, both on air and on their usual oxygen therapy - this should be monitored in line with the care plan
• the escalation plan for any person on home oxygen under your care
• who to contact if they are unwell and what to do
• personal emergency evacuation plan (PEEP).

Good practice

Do not turn up a person’s home oxygen supply without discussion with a specialist. You should also advise the person not to do this. Contact a clinician for advice.

A specialist must assess the person before making changes to their home oxygen.

You must know who your local home oxygen specialist team is and how to contact them. This is very important for people who are admitted to your service.

Make sure a risk assessment has taken place for any person on home oxygen. Review this every year. Review more often if there is a concern or any changes.

Make sure oxygen masks and tubing are clean and in good condition. Arrange for them to be replaced when needed. Only use them for the person they were prescribed for.

Never use one person’s oxygen equipment for another person.

If oxygen equipment is no longer needed or is out of date, contact the oxygen provider to remove it. Do not store this for use elsewhere.

Safety

Oxygen can be a dangerous fire hazard. Take adequate precautions while oxygen is being used.

Home oxygen should not be prescribed to a current smoker. If you are concerned about oxygen and smoking, contact your local home oxygen team and/or the prescriber of the oxygen immediately.

People should not smoke where oxygen is being used.

Keep oxygen at least two metres away from flames or heat sources.

Do not use flammable liquids, such as paint thinners or aerosols, near oxygen.

Do not use petroleum-based products (such as Vaseline® or Vicks®) or other emollients near oxygen.

Make sure that fire alarms and smoke detectors are working.

Include oxygen use in your fire risk assessment and take advice where needed.

Storage

Follow the manufacturer's advice on how to store oxygen.

Store oxygen cylinders:

• securely to prevent the cylinder from falling
• away from areas that would block escape routes or fire exits
• in well ventilated areas
• away from heat and light sources
• in an area that is not used to store any other flammable materials
• away from combustible material (such as paper, cardboard, curtains)
• so that they are not covered by items of clothing.

Store oxygen concentrators upright. Plug them directly into the mains. Do not use an extension lead.

Place statutory hazard notices in areas where you store oxygen. This includes the person's bedroom.

Oxygen cylinders have an expiry date. Check the dates regularly to make sure you don't use out of date cylinders.

Holding stock for emergency use

If you hold supplies of oxygen for emergency use, you need appropriate equipment and storage. You must have a written policy outlining how and when emergency oxygen is to be used. Staff must be regularly trained in emergency oxygen use and in the details of the policy.

Staff training

All staff involved in the use of home oxygen, must have appropriate and ongoing training in safe oxygen storage and use. Oxygen saturations must be monitored according to an agreed care plan for each person on home oxygen. This may mean they need to know how to access and use an oxygen saturation probe (SATs machine).

The oxygen care plan should include the normal oxygen saturations for the person (both on air and on their usual oxygen therapy). This should be monitored daily as part of their regular care. Staff must be able to monitor and respond to a resident’s oxygen saturations in line with their care plan.

See: Primary care medicines support for people living in care homes

Patient safety alert

Make sure your staff are familiar with this patient safety alert from January 2018.

Record keeping

Individual residents’ care plans and medicine administration records must detail:

• the reason for home oxygen use
• who prescribed it
• the prescribed flow rate
• duration and device used
• the oxygen monitoring plan.

The oxygen care plan must also include:

• details of target oxygen saturations
• escalation plan in the case of clinical deterioration
• details of the risk assessment
• date the risk assessment was done.

Policies and procedures

There must not be a blanket policy for general oxygen use on an 'as required' basis.

Complete a risk assessment around home oxygen use as part of general policies and procedures.

Consider how the emergency services are told where oxygen is if they attend a fire or fire alarm.

Inform the local UK power network that a service user has home oxygen. This means that they will be aware of your special needs if the power supply is ever interrupted.

Have a policy for dealing with a person's oxygen needs when planning trips away.

Make written information available for people about home oxygen. Care plans should include the risks associated with:

• smoking (including risks with electronic cigarettes)
• heat sources (such as heaters in bedrooms)
• flammable liquids (such as aerosols)
• petroleum based products and other emollient preparations
• using electronic devices (such as laptops).

The organisation supplying the oxygen are responsible for annual maintenance of oxygen equipment. This includes reporting faulty equipment and arrange replacements.