Oxygen is a medical gas. You should treat it as a medicine.
Some people living in their own homes use oxygen. This means they use a cylinder or machine to breath air that contains more oxygen than normal air. 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 using 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 to use the oxygen as prescribed
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 and risk assessment
Do not turn up a person’s home oxygen supply without discussion with a specialist. Instead, contact a specialist who can assess the person’s needs before making changes to their prescription.
You should also advise the person not to turn up their own oxygen supply.
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 Replace them when needed. Only use them for the person they were prescribed for.
If oxygen equipment is no longer needed or is out of date, inform the healthcare professional who prescribed it so that the oxygen provider can remove it.
See home oxygen treatment information at nhs.uk
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 and people should not smoke where oxygen is being used.
If you are concerned about oxygen and smoking, contact your local home oxygen team or the prescriber of the oxygen immediately.
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.
Always turn off oxygen equipment when it is not being used.
Include oxygen use in any fire risk assessment and take advice where needed.
Help people to access and understand the safety information supplied with their home oxygen.
The organisation supplying the oxygen are responsible for annual maintenance of oxygen equipment. This includes the upkeep, reporting and replacement of faulty equipment.
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).
Make sure your staff are familiar with this NHS patient safety alert from January 2018.
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.
Oxygen cylinders have an expiry date. Check the dates regularly to make sure people don’t use out of date cylinders.
Staff training
All staff involved in the use of home oxygen must have appropriate and ongoing training in safe oxygen storage and use. If oxygen saturations are needed, they must be monitored according to an agreed care plan for each person on home oxygen. This may mean that staff and the person being supported 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 person’s oxygen saturations in line with their care plan.
See Pulse Oximetry at home at nhs.uk
Record keeping
Individual peoples’ 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.
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 person has home oxygen. This means that they will be aware of their special needs if the power supply is ever interrupted.
Consider how people can be supported to manage their oxygen needs when planning trips away.
See administering medicines when a person is away from their usual care setting
This page is for:
Adult social care services
For further advice, contact medicines.enquiries@cqc.org.uk