CHHS17/282

Canberra Hospital and Health ServicesClinical ProcedureACT Domiciliary Oxygen and Respiratory Support Scheme (DORSS)Contents

Contents....................................................................................................................................1

Purpose.....................................................................................................................................2

Scope........................................................................................................................................ 2

Section 1 – Application Information..........................................................................................2

Section 2 – Medical Eligibility....................................................................................................5

Section 3 – Review of Supply....................................................................................................9

Implementation........................................................................................................................ 9

Related Policies, Procedures, Guidelines and Legislation.......................................................10

References.............................................................................................................................. 10

Definition of Terms................................................................................................................. 10

Search Terms.......................................................................................................................... 11

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Purpose

This procedure defines the eligibility criteria for the supply of oxygen and respiratory equipment by the ACT Domiciliary Oxygen and Respiratory Support Scheme (DORSS), the governance of the scheme, the types of equipment provided, and the ownership of equipment supplied through the scheme.

Scope

This procedure applies to the following: ACT DORSS staff ACT DORSS Advisory Committee Authorised prescribers to ACT DORSS Clients of ACT DORSS.

Section 1 – Application Information

Eligibility Criteria To be eligible for the ACT DORSS individuals must: Be a permanent resident of the ACT Be living in the community (excluding high level care nursing homes) Be an Australian citizen or the holder of a permanent visa Have not received compensation through insurance or legal recourse or damages in

respect of the disability for which the item has been prescribed. However in exceptional circumstances where an applicant has received a compensation payment, some years have elapsed and the applicant can demonstrate hardship, discretion may be used to provide assistance under the ACT DORSS

Be ineligible to receive the equipment requested from any other funding program Not be an outpatient who is provided with long-term equipment by their treating

hospital for an acute medical condition Not be able to make an equivalent claim for the required appliance through their Private

Health Fund Meet the medical eligibility criteria for the supply of oxygen and related respiratory

supplies as stated in References in this document in line with the Thoracic Society of Australia and New Zealand (TSANZ) guidelines (Adult Domiciliary Oxygen Therapy)

Be referred by an approved consultant or approved advanced trainee using the Referral to the ACT Domiciliary Oxygen Support Scheme form – 25505 (0212) found on the clinical forms register.

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Oxygen Oxygen is available to all people who meet the eligibility criteria regardless of their

income or their parents’ or partner’s income. Oxygen equipment will not be provided to hospital in-patients as DORSS only provides

equipment for clients in the community. Equipment Allowance:

o Clients are only eligible for one government-funded concentrator and regulator at a time

o New clients to the scheme may be eligible for two portable cylinders at initial set up, and one free refill per month. This will only be provided on appropriate referral

o Portable oxygen allocation may be increased to a maximum of 4 cylinders per month or one refill per week with prescription from an authorised prescriber

o Transplant clients may be eligible for a maximum of sixteen portable C Cylinders per month or four refills per week.

Continuous Positive Airway Pressure (CPAP) / Variable Positive Airway Pressure (VPAP) Children - Persons under 16 years are eligible for assistance if they hold a current

Centrelink pension or Health Care Card and meet the application requirements. Adults - Persons 16 years and over are eligible if they hold a current means tested

Centrelink pension or Health Care Card and meet the eligibility criteria.

Nasal High Flow Humidifier A completed Nasal High Flow (NHF) referral form must be completed and forwarded to

the DORSS Administration Officer requesting the equipment including the current diagnosis and documented reason for request/benefit to the client.

Applicants will be provided with a disposable chamber, tubing and nasal interface on initial application only.

Laryngectomy Equipment (including Heat Moisture Exchange (HME) systems, Electrolarynx and Voice Prosthesis) A completed Laryngectomy referral form must be completed and forwarded to the

DORSS Administration Officer from an approved speech pathologist (with >1 year experience in laryngectomy area) requesting the equipment including the current diagnosis and justification. Clients will be allocated consumables in line with recommended allocation – i.e. one item per day for HME (Heat Moisture Exchangers) and one item per day for base plates, as per below:

Voice AllocationElectrolarynxOrIndwelling Voice ProsthesisOr Non-indwelling Voice Prosthesis

1 OrUp to 2 per yearOrUp to 6 per year

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Respiratory Consumables AllocationHME CassettesOrFoam Stoma Covers

365 per yearOr365 per year

HME attachment devices:Tracheostoma buttonOrStandard adhesive seals (base plates)OrNon-standard adhesive seals (base plates)

1 per yearOr365 per yearOr180 per year

Laryngectomy 1 per yearLaryngectomy tubes securing device:Neck straps

12 per year

Consumables will be ordered and delivered to the prescribing speech pathologist and the client/carer contacted to collect

Funding for consumables will only be approved if the client has successfully trialled the items and they are required for long term use

Funding will not be provided for supply requests above the allocated amount (as listed above)

Clients must have a current eligible means tested Centrelink Pension or Health Care Card and meet the eligibility criteria

The client must not be eligible to receive equivalent assistance from another funding source

Exclusions:o Cloth Stoma Coverso Shower Coverso Lubricanto Silicone Adhesiveo Plug inserts for voice prostheses

Payments / Client ContributionsClients are not required to make any payments and/or contributions with the exception of replacement consumables for the Nasal High Flow Humidifier (NHFH) and replacement masks, filters, and tubing for CPAP/Bilevel machines.

RetrospectivityThe ACT DORSS does not operate with any retrospective effect. This includes oxygen and respiratory equipment purchased before obtaining funding through DORSS and/or repair of items issued under the scheme

Ownership of equipmentAll equipment provided for client use through the ACT DORSS (other than consumables such as masking, tubing and HME items) is the property of ACT Government - Health Directorate or the ACT Government contracted service provider at the time.

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Section 2 – Medical Eligibility

Supply of Home Oxygen and Associated ComponentsApplications are assessed for continuous oxygen therapy (at least 15 hours per day) eligibility according to the Position Statement of the Thoracic Society of Australia and New Zealand.

Applicants must have: a partial pressure of oxygen in arterial blood (PaO2) of ≤ 55 mmHg (7.3kPa) and/or

Oxygen Saturation < 90% and chronic hypoxemia or Cor Pulmonale PaO2 56 - 59mmHg and/or a completed application form from an authorised prescriber including:

o the type of equipment prescribedo Arterial Blood Gas (ABG) and/or oxygen saturation resultso the prescription (flow rate, delivery method etc.).

Applications which are outside medical eligibility but have additional supporting information from an approved consultant may be presented at the DORSS Advisory Committee for special consideration.

Application processing Applications for clients being discharged from hospital within the ACT, that meet

application requirements, will be processed within 1 working day and forwarded to the supplier. Clients will then be contacted by the supplier to arrange delivery.

Wherever possible, if a client requires assistance while in the community and meets the application requirements, their application will be processed by the next working day.

In special circumstances, or for urgent applications, referrals need to be made to the DORSS Advisory Committee, or to the Executive Sub-Group consisting of a Respiratory Physician, Committee Chair (Director of Client Support Services) and Executive Director – Rehabilitation Aged and Community Care (RACC).

High Flow Oxygen SupplyFor clients to be eligible for supply of high flow cylinder oxygen they must: require domiciliary oxygen 24 hours per day and/or demonstrate via assessment a medical need supporting the benefits of high flow oxygen

for their relevant condition.

Application processing Clients requesting assistance for the supply of cylinders for high flow oxygen will require

a referral from an approved consultant. The letter must contain a complete prescription. After approval the Oxygen and Respiratory Administration Officer will place an order

with the contracted supplier.

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Unsuccessful applicants will be informed in writing and advised of the ACT Health Directorate complaint / appeal process.

Palliative Oxygen Supply Palliative oxygen supply will be provided in accordance with TSANZ guidelines. Palliative oxygen supply may be prescribed for “symptomatic relief” in patients with a

very limited prognosis. This is appropriate in the later stages of a patient’s illness to relieve the distress and anxiety associated with dyspnoea.

Note: Can be prescribed by Palliative Care Nurse Practitioners with their prescribing rights limited to home oxygen therapy for palliative care patients.

Babies going home on Oxygen under the care of Newborn & Parent Support Service Home oxygen equipment can be supplied to babies who are permanent residents of the

ACT and where a referral is received from a paediatrician The following equipment can be supplied:

o E cylinder with low flow paediatric regulatoro C cylinders with low flow paediatric regulatoro C cylinder carry bago Infant nasal cannulas and long tubing.

Supply of portable / backup cylinders Portable / backup oxygen cylinders will not routinely be supplied Application for the supply of backup cylinder oxygen is to be provided by an approved

consultant before supply is approved Approved applicants will be provided with two (2) cylinders and the prescribed

regulator. Refills will be allocated at one cylinder refill per month.

Application Processing Prescriptions requesting more than two cylinders per month, or enhanced supply will be

considered for approval by the DORSS Advisory Committee based on the evidence provided.

Patients requiring more than the standard portable oxygen allowance need their specialist to fill in an updated application form, found on the clinical forms register, and fax it to the DORRS Administration Officer on 6205 2604 for consideration.

Following approval, the client will be advised of the process for ordering and the supply limit, prior to an order with the contracted supplier being placed for the client. All supplies will be ordered and authorised by the DORRS Administration Officer.

All unsuccessful applicants will be advised in writing and will also be advised of the ACT Government Health Directorate complaint / appeal processes. Applicants will also be advised that the declined application may be resubmitted to the ACT DORSS Advisory Committee for reconsideration should there be further supporting medical information.

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NHF Humidifier Supply Clients requiring the use of NHF Humidification will require a referral from an approved

prescriber; this must contain a complete prescription. After approval the Oxygen and Respiratory Officer will arrange for the loan of the

equipment upon availability. Machines will be bar-coded and if there are none available the client will go on to a waiting list for the next available device.

This equipment can be collected from the Village Creek Centre and arrangements can be made through the Thoracic Department at The Canberra Hospital for set up.

Applicants will be provided with a disposable chamber, tubing and consumables on initial application only.

Current guidelines on how long consumables last: o Tubing maximum 2 monthso Air Filter maximum 3 monthso Nasal Interface (small, medium or large) maximum 1 month (junior interface 1 week)

The NHF humidifiers will be stored and cleaned at Village Creek Centre.

Supply of CPAP units and related items Applicants must: be assessed and referred by an approved consultant have completed studies at a recognised sleep study unit within the last twelve months

and successfully trialled the recommended unit for a minimum of 1 month. meet the following for obstructive sleep apnoea (OSA):

i. have symptoms attributable to OSA, e.g. excessive daytime sleepiness, impaired memory and concentration, daytime respiratory failure

ii. have a diagnosis of severe or moderately-severe OSA confirmed by polysomnography as indicated below:o severe OSA is diagnosed where Respiratory Disturbance Index (RDI) > 30 o moderately-severe OSA is diagnosed where RDI > 20 and minimum overnight

Oxygen Saturation < 90%o patients with an RDI > 10 accompanied by symptoms of excessive daytime

sleepiness and documented cardiovascular diseases including hypertension, ischaemic heart disease or stroke.

Application Processing Once a referral is received and eligibility is established, the application will be processed

by the DORSS Administration Officer Client applications that do not meet the eligibility criteria will not be considered for

supply Unsuccessful applicants will be informed in writing and advised of the Health

Directorate complaint / appeal process In special circumstances or for urgent applications, referrals will be made to the DORSS

Advisory Committee or to the Executive Sub-Group consisting of the Respiratory Physician, Committee Chair (Director of Client Support Services) and Executive Director, RACC

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Applicants will be provided with one mask and associated tubing on initial application only

Replacement / repair of respiratory unit mask, tubing and filters is the responsibility of the client

All respiratory units, repairs and maintenance will be supplied and carried out through the current ACT Government Health Directorate DORSS Purchasing Contract

The Oxygen and Respiratory Administration Officer will conduct an annual audit to ascertain client compliance, eligibility and use of equipment.

Supply of Bilevel units and related items Applicants must: Be assessed and referred by an approved consultant who will decide on the suitability of

these therapies For Bilevel units patient must have:

o Severe sleep apnoea (Severe sleep apnoea is defined as an RDI (apnoea + hypopnoea + RERA (respiratory-effort related arousals) index) > 30 associated with symptoms consistent with the obstructive sleep apnoea syndrome) and/or

o Sleep-related hypoventilation as demonstrated by increasing transcutaneous carbon dioxide (CO2) level, persistent hypoxia despite absence of airway obstruction during sleep study and those with daytime hypercapnoea.

Have completed studies at a recognised sleep study unit and have successfully trialled the recommended unit. Evidence of the successful trial must be endorsed by the referring consultant and provided with the application

In the case of Type 2 respiratory failure (hypercapnoea), the equipment may be deemed “life sustaining” and a trial may not be required based on appropriate referral and advice from the referring consultant

CPAP/Bilevel equipment will not be delivered to hospital in-patients as DORSS only provides equipment for clients living in the community.

Application Processing Once eligibility is established, the application will be processed by the DORSS

Administration Officer Client applications that do not meet the eligibility criteria will not be considered for

supply and the unsuccessful applicants will be informed in writing and advised of the Health Directorate complaint / appeal process

In special circumstances or for urgent applications a referral will be made to either the DORSS Advisory Committee or to the Executive Sub-Group consisting of the Respiratory Physician, Committee Chair (Director of Client Support Services) and Executive Director, RACC.

Applicants will be provided with one mask and associated tubing on initial application only

Replacement / repair of mask and tubing is the responsibility of the client All units and accessories, repairs and maintenance will be supplied and carried out

through the current ACT Government Health Directorate DORSS Purchasing Contract.

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The DORSS Administration Officer will conduct an annual audit to ascertain client compliance, eligibility and use of equipment.

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Section 3 – Review of Supply

Review of Oxygen SupplyAll clients receiving oxygen supply will have an annual review of their need for continued supply. Annual review will involve the completion of the Annual Review Re-assessment form and submission to the DORSS Administration Officer.

All client re-assessments will be checked against the ACT Government - Health Directorate Supply of Home Oxygen Clinical eligibility criteria as in section 2 of this procedure. Where clients do not meet the criteria, funding support may be discontinued.

Requests for re-assessment will be monitored by the DORSS Administration Officer. Where there is no response from a client within three (3) months of notification being issued, the request will be referred to the DORSS Advisory Committee.

The DORSS Advisory Committee will review the client file and any supporting documentation / advice received in relation to the non-compliance and provide advice on action / possible discontinuation of supply.

Review of Respiratory Clients All clients receiving CPAP/Bilevel will undertake an annual review of their need for

continued supply. The annual review will involve the completion of the Annual Review Re-assessment form and submission to the DORSS Administration Officer. This will include a request for a copy of the clients current Centrelink Pension/Health Care Card to confirm eligibility.

All client re-assessments will be checked against the ACT Government - Health Directorate DORSS and clinical eligibility criteria. Where clients do not meet the criteria, funding support may be discontinued on advice from the DORSS Advisory Committee.

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Implementation

This procedure will be located on the policy register. It will be communicated to staff through staff meetings and will be incorporated into the orientation process of new DORSS staff.

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Related Policies, Procedures, Guidelines and Legislation

Guidelines Adult Domiciliary Oxygen Therapy, Thoracic Society of Australia and New Zealand 2005

Legislation Human Rights Act 2004 Health Records (Privacy and Access) Act 1997 Work Health and Safety Act 2011

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References

1. Adult domiciliary oxygen therapy - Position Statement of the Thoracic Society of Australia and New Zealand 2005 Guidelines http://www.mja.com.au/public/issues/182_12_200605/mcd10865_fm.html

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Definition of Terms

Accessories: Other items associated with the units or equipment.Consumables: Masking, tubing, nasal cannulas and any other personal use item which

cannot be cleaned and reissued.CPAP: Continuous Positive Airway PressureDORSS: Domiciliary Oxygen and Respiratory Support SchemeNIV: Non Invasive VentilationPaO2: partial pressure of oxygen in arterial blood, measured in mmHg.RACC: Rehabilitation Aged and Community Care TSANZ: Thoracic Society of Australia and New ZealandVPAP: Variable Positive Airway PressureNHF: Nasal High Flow

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Search Terms

Oxygen, Oxygen inhalation therapy, Hypoxia, Blood Gas, Sleep Apnoea, Continuous positive airway pressure, CPAP, Intermittent positive pressure breathing, VPAP, NHF, humidifier,

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Disclaimer: This document has been developed by ACT Health, Canberra Hospital and Health Services specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.

Policy Team ONLY to complete the following:Date Amended Section Amended Divisional Approval Final Approval 15/11/2017 Complete Revision Linda Kohlhagen, ED

RACCCHHS Policy Committee

This document supersedes the following: Document Number Document NameCHHS14/034 ACT Domiciliary Oxygen and Respiratory Support Scheme (DORSS)

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