NHS England and NHS Improvement have supplied us with guidance from some Trusts that in the early stages of the current wave saw their oxygen consumption increase rapidly and putting their systems under heavy load.
- The COVID-19 Pandemic and actions necessary to mitigate its effect on the performance of Healthcare Cryogenic Liquid Oxygen Systems
- Homerton COVID and Flu Manual for IMRS Version 4 – January 2021
- Oxygen Consumption Monitoring within the University Hospitals of Leicester
- Piped Oxygen Supply Business Continuity Plan V2
- Good Oxygen Housekeeping
- High Flow Medical Oxygen 101-W Cylinder FINALMYHT keeping patients safe – oxygen demand and capacity 11-11-20
- Barnsley Hospital Nov 2020
- Barnsley SOP The Management of Oxygen v0.5
- St Helier Hospital Piped Oxygen Demand Management Plan
The messages are essential:
- Good estates management of the VIE plant with regular checks and de-icing
- Understanding and confirming the parameters of the system and available flow capacity. Then cross-checking that with any limitation within infrastructure/pipework
- Measuring available flow and limit at ward level and ensuring patients on high oxygen demand are not all grouped together in one area that perhaps has limited pipework capacity
- Working closely with the clinical team to
- Ensure they understand the limits of the system
- Understand their levels of O2 prescribing and checking with any onsite flow monitoring to ensure a match
- The clinical team is well led by a champion who ensures daily checks on each patient are being made to ensure they are receiving the O2 level prescribed
- Working with the Central supply team to access the most efficient ventilators etc and drawing on central stocks of concentrators (5 l/min) for those patients not needing high flow
- Making sure unused equipment is closed
- Consider staggering meal times when patients may be moved from CPAP to High flow nasal (and leaving CPAP open)
Basically the process of improvement:
- Know what you have by accurate measurement and triangulation of information from different sources
- Work as an MDT (estates and clinicians) to understand the demand and need
- Identify appropriate champions to communicate, communicate and communicate
- Incremental improvement – the sum of small steps