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Home | Articles | Adult Home Oxygen

Adult Home Oxygen

Last updated 15th April 2025

Introduction

  1. NHS D&G Adult home oxygen service is managed by the Integrated Respiratory Team and includes Respiratory Nurse Specialists (RNS) and a Clinical Lead Respiratory Consultant.
  2. The risk from delivering too much or too little Oxygen in this vulnerable group, i.e. patients with COPD, interstitial lung disease or other chronic respiratory conditions, is well recognised yet patients can still come to harm.
  3. To improve safety, oxygen must be prescribed to a defined flow rate and the circumstance of use.
  4. Acute illness can change oxygen requirements for a Home oxygen patient and require reassessment which can be supported through the RNS team. Please seek advice if you remain unsure and before changing an oxygen prescription.

RNS Contact Details

  1. Patients in DGRI: Yvonne Scott –  01387 246246 (ext.32007)/Susan McGill – 01387 246246 (ext.31576)
  2. Community East: Kayrine Stewart – 07738500448/Susan Shearer – 07920540273
  3. Community West: Bruce Watt – 07736955354/Shona Jardine/John Duncan – 07920540646

Key Points Described on this Page

  1. The difference between Ambulatory oxygen and long term oxygen therapy
  2. A range of home oxygen delivery systems
  3. Red flags
  4. Important points for patients who are admitted to hospital who are on home oxygen

Home Oxygen Assessment

  1. This is performed by the RNS and determines what type of oxygen therapy is suitable for the individual patient and highlights any safety concerns.
  2. The RNS will consider:
    • smoking status and presence of smokers within the property
    • any other combustion risks
    • trip and falls risk
    • cognitive function and other concerns that impact on safety
  3. The RNSs are working towards adding alerts on the person summary page of clinical portal for patients on home oxygen.  There will also be a clinical note & GP letter on clinical portal (respiratory section) detailing the home oxygen prescription and patients are also given a home oxygen card detailing their prescription.

Long Term Oxygen Therapy (LTOT)

  1. LTOT is worn for 15 to 24 hours per day
  2. Flow rate and duration of use is determined at a Clinic review and requires an arterial blood gas (ABG). Oxygen is titrated and safety confirmed by a repeat ABG and this checks that –
    • Hypoxia has been adequately corrected
    • CO2 has not risen which would suggest risk of hypercapnic respiratory failure (ie harm from CO2 build up)
  3. Titration of oxygen is performed by a skilled team (RNS) in a controlled environment to generate a safe prescription for LTOT. Further change or titration should not be performed without consultation with the RNS.
  4. The RNS will complete a Scottish Home Oxygen Order form (SHOOF) and send to the National Home Oxygen provider. The SHOOF clarifies Oxygen flow rate (litres/min) and details how long the patient will use Oxygen in a 24 hour period. It is therefore an essential safety requirement that any titration of oxygen is only performed in consultation with the RNS.

Ambulatory Oxygen Therapy (AOT)

  1. AOT may be used as a single therapy or in addition to LTOT when a person needs to increase oxygen flow rate during exertion.
  2. AOT is also helpful when a patient has a satisfactory resting oxygen but a significant drop when they attempt to mobilise.
  3. An AOT assessment can be performed at home by the RNS and does not require an ABG. An order form will be completed by the RNS.

Home Oxygen Delivery Systems (understanding the terminology and pitfalls)

  1. Static concentrators – produce oxygen within the home and are mostly used for LTOT. They can be used for AOT if needed only within the house.
  2. Portable concentrators – mostly used for AOT outside the house.
  3. Oxygen cylinders – for AOT in or out of the house
  4. Liquid oxygen – patient given a supply in the house and fills the flasks for use outside the house
  5. 5Nasal cannulae – are suitable for most patients on home Oxygen
  6. Simple face mask – can be used for short periods to allow for a break from nasal cannula to reduce nasal dryness

Pitfalls

  1. Do not switch a patient who is using a static concentrator from AOT to LTOT without a safety assessment by the RNS.
  2. Portable concentrators are not suitable for LTOT
  3. Venturi face masks are not compatible with oxygen concentrators and should not be used

Patient on LTOT Becomes More Hypoxic in the Community

  1. This is a sign of a deteriorating patient
  2. This should be discussed urgently with the RNS – neither patient nor community clinician should increase the rate of oxygen without a discussion or considering hospital admission.
  3. For safety reasons the patient is likely to need an ABG or transcutaneous CO2 level checked and monitored whilst cause of deterioration is clarified.
  4. During urgent hospital admission, any increase in oxygen requirement above usual LTOT rate should be considered a ‘NEW’ Oxygen requirement and managed accordingly with ABG and scoring on NEWS

Patient on AOT Becomes More Hypoxic in the Community

  1. This is a sign of a deteriorating patient.
  2. Please do not attempt to correct hypoxia by switching from AOT to LTOT without support from RNS or hospital admission for re-assessment

A Change in Circumstances Which Highlights a Risk to Patient on Home Oxygen or to Others

  1. The RNS will contact the patient 2-4 weeks after Oxygen equipment is installed
  2. The patient will be re-assessed (face to face) at 3 and 6 months and then annual reviews if stable.
  3. A risk assessment is repeated at each review but if any health or social care professional becomes aware of a change that increases the risk of Home oxygen, they must contact the RNS via switchboard (01387 246246) asking for RNS (Mon-Fri 9-5 pm) who will expedite an early review.

Types of Concerns That Have Required Intervention Include

  1. Patients has resumed smoking or others are smoking in the presence of patient who is on oxygen
  2. Substance misuse that increases risk in the setting of home oxygen
  3. Change in cognitive function such that the patient can no longer manage oxygen independently or recognise the risks of home oxygen therapy including combustion risk
  4. Increasing risk of trips or falls for the patient or other member of the household
  5. Please discuss other concerns with the RNS

Pitfalls When Patient Admitted to Hospital

  1. Failing to recognise the new oxygen requirement when a patient previously on AOT requires continuous therapy or their continuous flow rate increases above their normal baseline LTOT rate.  This should be scored on NEWS as a new requirement and prompt ABG and further assessment undertaken.
  2. Failing to remember that the flow rate (litres/min) for home Oxygen is calculated for nasal cannula. This will not be the appropriate rate for a deteriorating patient who requires a Venturi mask. Please ask if you are unsure what to prescribe as they are completely different systems.

Hospital Discharge for Patients on AOT/LTOT

  1. Use the return to baseline oxygen requirement as part of the discharge criteria.
  2. Do not try to discharge earlier simply because oxygen is available at home.
  3. Please involve the RNS who may need to re-assess oxygen requirements and equipment provision.
  4. When planning discharge home or transfer to Community Hospital please discuss any changes in oxygen requirements with RNS to ensure the oxygen prescription remains appropriate and supplies are in place.

Links

  1. British Thoracic Society Guidelines on Home Oxygen Use for Adults