Breakout 3.5 ‘Dying for a fag’ The hypoxic patient actively smoking – case study - Sue Smith

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DERBYSHIRE HOME OXYGEN

SERVICE ASSESSMENT & REVIEW

‘DYING FOR A FAG’

THE HYPOXIC PATIENT ACTIVELY

SMOKING –

A CASE STUDY

DERBYSHIRE HOME OXYGEN SERVICE

ASSESSMENT & REVIEW

Evidence of benefit

The two landmark trials (NOTT 1980 & MRC 1981) used for Guidance on prescribing Home Oxygen - no exclusion of smokers.

MRC trial – 43% of subjects current smokers

NOTT – 39% of subjects current smokers

More recently –

Nice 2004 & BTS 2006

‘smoking cessation techniques should be continued prior to any home oxygen assessment. Patients should be made aware of the dangers of continuing to smoke”

Therefore they set precedents that are now accepted in clinical practice.

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ASSESSMENT & REVIEW

0

200

400

600

800active Oxygen

Patients

smokers

successfully

stopped smoking

continued to smoke

risk assessments

SOUTH DERBYSHIRE 2011 - 2012

750 patients actively using Home Oxygen

110 Active smokers

82 successfully stopped smoking

28 continued to smoke –

Have proven ‘safe’ smoking – switch Oxygen off, move outside at best, into a closed door room at worst.

All of these have formal risk assessments undertaken & regular follow up


ASSESSMENT & REVIEW

PATIENT IDENTIFIED AS BEING AT RISK

FROM SMOKING & USING OXYGEN

INFORM OXYGEN COMPANY

INFORM FIRE SAFETY OFFICER

HOME RISK ASSESSMENT.

PATIENT, OXYGEN PRACTITIONER,

FIRE SAFETY OFFICER

PATIENT

TO SIGN PAPERWORK

COMPLETE PAPERWORK

& FILE IN NOTES

ENSURE PATIENT AWARE OF RISK,

GIVE COPIES OF LEAFLET.

PATIENT AWARE OXYGEN COULD BE

REMOVED IF RISK TOO GREAT -

3 WITNESSED EPISODES SMOKING

Managed ‘safely’ Continue to put themselves

& others at risk

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ASSESSMENT & REVIEW

Case study

62yr old, COPD with severe Type 2 Respiratory Failure

Established Home Oxygen user (Since 2007)

‘cold call’ visit 6 weeks post discharge

Oxygen in situ, but obvious signs of smoking whilst on Oxygen

Declined any risk assessments / fire service etc

Became agitated when removal of Oxygen mentioned

Deteriorating Type 2 Respiratory Failure


ASSESSMENT & REVIEW

Refused admission

Refused input from GP

Agitated – Wanting me out his home

Became so unwell – neighbour dialled 999

Triggered ‘3 strike rule’

Removal would result in hastened death

Agreement sought form local legal /

ethical committee

Counsel advice

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Risk Management

Clinical Effectiveness

Patient / Public focus

CLINICAL GOVERNANCE

PATIENT

SAFETY


ASSESSMENT & REVIEW

Derbyshire Home Oxygen Service / Fire and Rescue Service

Information to support the memorandum of understanding between the NHS and DFRS to supply safety advice and

practical measures to improve fire safety in the home for home oxygen users

March 2010

1 Derbyshire Fire and Rescue Service (DFRS) will work in partnership with the NHS, and others as appropriate, to enhance fire safety in the home for home oxygen users.

2 This will include the provision of fire safety advice for the occupant(s) of identified

domestic premises and the provision of free smoke detectors if appropriate.

3 Any other items deemed desirable, such as fire retardant bedding packs, will normally be provided by the NHS or other partners.

4 DFRS will endeavour to support this work as far as is reasonably practicable but this

will depend upon the availability of suitably trained DFRS Community Safety Officers (CSOs) and financial support from internal/external budgets.

5 The joint DFRS/NHS Home Fire Safety Checks (HFSCs) to support this partnership

will be conducted by DFRS Community Safety Officers and nominated NHS staff. This will allow joint activity to reduce the potential for unwanted fires in the property as far as possible.

6 There will normally be 2 ways by which a joint visit will be facilitated. Firstly, DFRS

staff may come into contact with a Home Oxygen User (HOU) during a routine HFSC. If this is the case, the HFSC will be completed and detectors fitted (if required). A referral form provided by the NHS will then be faxed to an agreed contact number giving details of the circumstances found in the premises. If a further joint visit is deemed necessary, this will ensue in due course. Consideration within DFRS needs to be given as to how a referral is made to the NHS if a Firefighter or Handyperson comes across a HOU and concerns are raised. It may be best that through awareness training or internal communication we set up a mechanism for them to inform their Area Office Manager/HFSC coordinator who will then inform an Area CSO who will refer to the NHS.

7 Secondly, NHS staff may enter the household of a HOU and have concerns about

fire safety and will make a faxed referral to the relevant DFRS Area Office for the individual concerned and a joint visit with a CSO will also ensue.

8 The NHS has offered to supply suitable transport for joint visits between DFRS and

the NHS in circumstances where this is either necessary or desirable. This will be in the NHS representatives own vehicle which will be suitably insured for this purpose and roadworthy. This will also allow 1 CSO to attend a household with the NHS representative so lone working does not occur.

REDUCING THE RISK OF FIRE IN SMOKERS WHO ARE ASSESSED AS NEEDING OXYGEN THERAPY Ref. No: Aim: To introduce a policy for reducing the risk of fire in patients who are prescribed oxygen, who are exposed / have the potential to be exposed to sources of fire & heat. This is a new policy, which aims to give the prescriber the tools to adequately manage the risks involved, to ensure a level of safety for the patient, relatives, visiting health care professionals, fire service and neighbouring properties. The aim is to maximise the use of available resources, with close working relationships between the Home Oxygen Service, The fire And Rescue Service for Derbyshire and local smoking cessation services. Whilst we aim to reduce the risk as much as possible it must be acknowledged that due to the nature of the issues involved, the risk cannot fully be eliminated.

Purpose and Scope:

Oxygen therapy has been the mainstay of therapy & treatment within acute hospitals for years. As a result of improved accessibility and local service developments, there is an

increasing cohort of patients in the community using home oxygen therapy services. The Home Oxygen service provides 90,000 patients in England and Wales with different models of home oxygen therapy and a tailored, patient-centred service. The new home

oxygen supply service commenced on the 1st February 2006, with Air Products being the contracted supplier of all oxygen modalities in the East Midlands. More recent Local

developments include the formation of the Home Oxygen Assessment Service for Derbyshire County & Derby City in May 2009. The objective is for Derbyshire County PCT to develop and improve clinical assessment

and follow up services to provide improved patient care and wellbeing. The registered population for the PCT is 747,500 with approximately 1343 in Derbyshire, and 900

patients in Derby City patients currently (July 2008) being provided with home oxygen therapy by Air Products. Most prescribing of Home Oxygen Therapy is currently initiated in Primary Care by GPs, though this is now being supplanted by the Derbyshire Home

Oxygen Service. There are many risks associated with Home Oxygen Therapy, mainly concerned with the

patients’ health and inadequate prescription of home oxygen. There are also risks associated with the incorrect use of oxygen therapy equipment and fire risks associated with exposure to flame or heat, oxygen enrichment of surrounding area, use of materials

not compatible with Oxygen therapy. This Policy predominantly covers Home Oxygen therapy users who continue to smoke,

but also incorporates basic safety aspects and risk reduction tools for all Home Oxygen patients.

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Patient Letter / Consent Safety Leaflet

Risk Assessment Documentation


ASSESSMENT & REVIEW



Risk Management



CLINICAL GOVERNANCE

PATIENT

SAFETY

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PART A HOOF –

» HOSPITAL DISCHARGE

» GP EMERGENCY OUT OF HOURS

» PALLIATIVE CARE ORDERS

Can we withhold Oxygen on suspicion alone?



Risk Management



CLINICAL GOVERNANCE

PATIENT

SAFETY

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RIGHT TO LIFE (and quality of life)

PATIENT AND PUBLIC

AWARENESS OF OXYGEN INDICATIONS AND SAFETY

LOCAL TRAINING

National Programme?


ASSESSMENT & REVIEW

Carer / neighbour

input

Oxygen Service

Access Home

visit

Multi Disciplinary

Team Meeting

Fire & Rescue

Social Services

Capacity

Assessment

Clinicians & Health

care Professionals

Patient safe

discharge

Home

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ASSESSMENT & REVIEW

Questions of current guidance

Can supplemental Oxygen be of clinical benefit Patients who continue

to smoke?

Do we make a ruling not to prescribe Oxygen for smokers irrespective

of their Hypoxia?


ASSESSMENT & REVIEW

QUESTIONS ? Sue Smith.

Oxygen Practitioner.

Derbyshire Home Oxygen Service Assessment & Review

Royal Derby Hospital

01332 787825

[email protected]

Breakout 3.5 ‘Dying for a fag’ The hypoxic patient actively smoking – case study - Sue Smith

Health & Medicine

Transcript of Breakout 3.5 ‘Dying for a fag’ The hypoxic patient actively smoking – case study - Sue Smith