6888 Improving oxygen prescribing in paediatrics

Objectives Oxygen is regarded a drug and should be prescribed according to British Thoracic Society (BTS) guidelines. However, in practice we predicted this is often not done, and target saturations are not recorded. This means some patients may not be weaned off oxygen as quickly as possible, potentially increasing length of stay and risks of hyper-oxygenation. We aimed to audit oxygen prescribing practice within the paediatric setting in a single Trust and evaluate whether education around the need to prescribe oxygen can change practice to encourage appropriate prescribing. Methods 146 patients aged 0–16 admitted to paediatric wards in November 2022 were screened using the electronic patient record database. We identified if oxygen was delivered and if so was it prescribed during their admission. If it was prescribed were target saturations recorded. The notes were analysed for details of oxygen delivery across the time course of admission, what the requirement for oxygen was and relevant instructions for delivery. We then implemented a teaching session in January 2022 to encourage doctors to prescribe oxygen. We placed posters in the paediatric emergency department and wards. We repeated the evaluation, screening 108 patients admitted in May 2023. Results In November 2022, 31 of 146 patients given oxygen had oxygen prescribed, with 100% of these with target saturations documented. In comparison in May 2023, following intervention, 44 out of 108 patients delivered oxygen had it prescribed, also with 100% of these having target saturations documented. For those not prescribed oxygen, the documentation of target saturations in the notes had increased following the intervention. (24% in Nov vs 67% in May). We identified when oxygen is prescribed in the electronic system, it is recorded as a 'therapy' and not a 'medication.' It is therefore not readily seen unless looked for by the nursing staff. Conclusion Oxygen was not prescribed according to gold standard practice in our initial analysis. Our teaching and posters on oxygen prescribing resulted in a significant improvement in prescribing practice (21% vs 40.7%). Future work should include education on oxygen prescribing as part of induction. Nursing teams should be educated about where to look for oxygen prescriptions. We could use our electronic system to identify individuals with good practice to act as 'O2 champions'. We aim to repeat the evaluation over the winter to gain equitable data on bronchiolitis patients to see if length of stay is reduced with improved prescribing.