The method of supplying long term oxygen therapy (LTOT) will be determined by the contractor.

Long term administration of oxygen (at least 15 hours/day generally overnight) may prolong survival in patients with severe chronic obstructive airways disease.

Indications- Patients with any of the following:

• PaO₂ less than 7.3 kPa with COPD or cystic fibrosis.
• PaO₂ less than 8.0 kPa with COPD, cystic fibrosis with any of the following
  • secondary polycythaemia
  • peripheral oedema
  • evidence of pulmonary hypertension
  • interstitial lung disease
  • nocturnal hypoxaemia
• Neuromuscular disease or skeletal disorders, with or without ventilation support, on referral to specialist.
• Obstructive sleep apnoea remaining hypoxic despite nasal CPAP.
• Palliation of dyspnoea in pulmonary malignancy and other diseases with disabling dyspnoea.

When assessing prior to possible use of long term oxygen:

• Blood gases (not oximetry) should be measured at least 4 weeks after an exacerbation. Measurements should be stable on at least 2 occasions at least 3 weeks apart.

Reference: Domiciliary Oxygen Therapy Service Clinical Guidelines and Advice for Prescribers - Report of the Royal College of Physicians

• Oxygen is a medicine and must be prescribed on the inpatient prescription
• The prescription should state the concentration required if given by a Venturi mask, or the flow rate if administered via a nasal cannula.
• Two litres of oxygen per minute delivered by a nasal cannula does not constitute controlled oxygen therapy and is not equivalent to an inspired concentration of 24%.
• In patients with unstable hypercapnoeic respiratory failure, venturi masks should be used to deliver controlled oxygen. In these patients oxygen prescriptions should be guided by arterial blood gases.

North Devon District Hospital: refer to the NDDH Oxygen Policy

Royal Devon & Exeter Hospital: refer to RD&E Policy

Long Term (LTOT), short burst and ambulatory

LTOT & Ambulatory O₂ should not normally be prescribed without a Respiratory specialist assessment unless for example for Palliative Care

• Complete HOOF and Patient Consent Form (HOCF) go to www.airliquidehomehealth.co.uk/hcp/
• Hospital or clinic: fax copy of HOOF to patient's GP

Emergency short burst

• Call Air Liquide on 0808 202 2229 to initiate supply.
• Complete HOOF, stating it is confirmation of the telephone order and complete Patient Consent Form (HOCF)
• To access the Part A and Part B HOOF go to www.airliquidehomehealth.co.uk/hcp/
• If O₂ is needed beyond 3 days, complete a second HOOF at the same time, stating when the routine oxygen supply commences and the emergency supply should cease.
• Hospital or clinic: fax copy of HOOF to patient's GP

Notes

1. An emergency O₂ prescription supply (4 hour response) costs significantly more than routine supply, and will continue for a minimum of three days and then until cancelled or a routine HOOF is received.

Some patients with COPD and other conditions are vulnerable to repeated episodes of hypercapnic respiratory failure. Such patients should be issued with an oxygen alert card and instructed to show it to the ambulance crew and emergency department staff in the event of an exacerbation.

A copy of the BTS Oxygen Alert Card can be downloaded HERE.

The supplier is contracted to provide the service until informed otherwise, and will continue to make a charge until notified it is to be withdrawn. Therefore it is essential that the supplier is informed as soon as possible where oxygen therapy is no longer required.